N897Remark Code (RARC)Active
N897 Remark Code - Missing Proof of Member Payment
The N897 remark code indicates that the claim was denied due to missing, incomplete, or invalid proof of member payment. This remark supplements a Claim Adjustment Reason Code that describes the adjustment related to the payment issue.
How It Relates to the Denial
The N897 remark typically accompanies adjustment reason codes that address payment discrepancies, such as those related to member responsibility or payment verification. The combination signals that the payer requires additional documentation to support the member's payment claim.
Common Scenarios
1A claim for a service rendered to a patient was submitted, but the remittance shows an adjustment for non-payment due to insufficient proof of payment from the member.
→ The N897 remark indicates that the payer could not verify the member's payment, suggesting that the biller must provide documentation to support the claim.
2A provider submitted a claim where the patient was responsible for a copayment, but the remittance returned with an adjustment stating that proof of the copayment was missing.
→ With the N897 remark, it is clear that the payer is requesting evidence of the patient's payment for the copayment, which must be submitted to resolve the issue.
3After billing for a service, a provider receives a remittance indicating a denial with an adjustment code for missing member payment proof.
→ The presence of the N897 remark shows that the payer is looking for additional proof that the member made the payment, signaling the need for further documentation.
What to Do
- Gather any proof of payment documents from the member, such as receipts or payment confirmations.
- Ensure that the payment documentation is complete and clearly shows the date, amount, and service covered.
- Submit the proof of member payment to the payer as a response to the denial. Make sure to reference the claim number.
What to Check
- Review the original claim submission to confirm what was billed and any notes regarding member payments.
- Check the remittance advice for the accompanying Claim Adjustment Reason Code for context on the denial.
- Look for any previous correspondence from the payer regarding payment verification requirements.