N767Remark Code (RARC)Active
N767 Remark Code - Medicaid Enrollment Required
The N767 remark code indicates that the provider must be enrolled in the member's Medicaid state program before the payer can process any claim benefits. This means that the lack of enrollment is a barrier to payment for the services billed.
How It Relates to the Denial
The N767 remark code typically accompanies claim adjustment reason codes that indicate a denial due to provider enrollment issues. The combination signals that the claim cannot be processed until the enrollment requirement is satisfied.
Common Scenarios
1A provider submitted a claim for a service performed for a Medicaid patient, but the payment was denied due to enrollment issues.
→ The N767 remark suggests that the claim was denied because the provider is not enrolled in the specific Medicaid program for that patient.
2An outpatient service was billed to Medicaid, but the remittance showed a denial with a claim adjustment reason code related to provider eligibility.
→ The presence of the N767 remark indicates that the denial is due to the provider's lack of enrollment in the Medicaid program associated with that patient.
3A claim for a routine check-up was returned with a denial, and the remittance included the N767 remark code along with a general denial reason.
→ This remark is pointing out that the provider's enrollment status is preventing the claim from being processed.
What to Do
- Confirm that the provider is enrolled in the correct Medicaid state program for the member.
- If not enrolled, initiate the enrollment process with the appropriate Medicaid office.
- Once enrollment is confirmed, resubmit the claim for processing.
What to Check
- The provider's enrollment status in the state Medicaid program.
- The member's Medicaid eligibility details.
- Any documentation or communication from the Medicaid program regarding enrollment requirements.