N906Remark Code (RARC)Active
N906 Remark Code - Service Not Covered Under Age 45
The N906 remark code indicates that the billed service is not covered by the payer when the patient is under the age of 45. This suggests that the payer has specific age restrictions regarding coverage for certain services, which should be reviewed when processing the claim.
How It Relates to the Denial
The N906 remark code typically accompanies a Claim Adjustment Reason Code that relates to a denial based on coverage criteria. This combination signals that the service was denied due to age-related policy restrictions outlined by the payer.
Common Scenarios
1A patient aged 30 received a preventive service that was billed to the payer. The remittance returned with a denial indicating the service was not covered due to age restrictions.
→ The N906 remark code clarifies that the denial is specifically because the patient is under 45, thus the service is not covered according to the payer's policy.
2A claim for a diagnostic procedure was submitted for a patient who is 40 years old. The remittance response included a denial with a reason code indicating non-coverage, followed by the N906 remark code.
→ The N906 remark code indicates that the payer's policy denies coverage for this procedure as the patient is still under the age threshold of 45.
3A procedure was billed for a 35-year-old patient, but the remittance advice shows a denial for service not covered. The accompanying N906 remark code was included in the response.
→ The presence of the N906 remark code confirms that the denial is due to the patient's age, and the service is not eligible for coverage as the patient is under 45.
What to Do
- Review the patient's age to confirm eligibility for the service.
- Check if the service billed has age-related coverage restrictions.
- Consider alternative services that may be covered for patients under age 45.
What to Check
- The patient's date of birth to ensure accurate age determination.
- The payer's policy documents regarding coverage limitations based on age.
- The specific service billed to determine if it falls under age restrictions.