N891Remark Code (RARC)Active
N891 Remark Code - Maximum Payment by Primary Insurance
The N891 remark code indicates that the primary insurance has already paid the maximum allowable amount for the billed service or procedure. As a result, no additional payment is expected from the secondary payer for this claim.
How It Relates to the Denial
Typically, the N891 remark code accompanies a Claim Adjustment Reason Code that indicates a payment adjustment due to the primary insurance's maximum allowance. This combination signals that the claim has been fully paid by the primary payer, and the secondary payer will not make further payments.
Common Scenarios
1A provider bills for a surgical procedure, and the primary insurance processes the claim, issuing a remittance that shows a large payment but indicates a maximum allowable amount was reached.
→ In this case, the N891 remark code confirms that the primary payer has fulfilled its obligation by paying the maximum allowable amount, so no further payment will be made by the secondary payer.
2A patient receives physical therapy services, and the primary insurer pays a specific limit for those services, resulting in a remittance with a claim adjustment reason code and the N891 remark code.
→ Here, the N891 remark code reinforces that the primary insurance has covered the maximum allowance for the therapy, meaning the secondary insurance is not liable for additional payment.
3A claim for a diagnostic imaging service is submitted, and the primary insurance remits payment indicating the maximum benefit has been utilized, along with the N891 remark.
→ The N891 remark code clarifies that the primary insurance has already reached its maximum payment limit for that imaging service, thus no further payments will be made.
What to Do
- Verify the primary insurance payment amount against the billed service to confirm it aligns with the maximum allowable payment reported.
- Do not submit the claim to the secondary payer as no further payment is expected based on the primary insurance's coverage.
What to Check
- The remittance advice from the primary insurance for the payment details and adjustment reason codes.
- The contract or policy details with the primary insurance to confirm the maximum allowable payment for the service rendered.
- The claim file to ensure that all billed services and payment amounts are accurately documented.