N907Remark Code (RARC)Active
N907 Remark Code - No Refund for 340B-Eligible Claims
The N907 remark code indicates that there will be no refund for the claim because it has been recognized as eligible for the 340B pricing program, which has a ceiling price that is lower than the maximum fair price. This means that the claim meets specific criteria under the Medicare Drug Price Negotiation Program, and therefore, a refund is not warranted.
How It Relates to the Denial
N907 typically accompanies Claim Adjustment Reason Codes that explain adjustments related to pricing disputes or refunds. The combination signals that the claim is subject to 340B pricing rules and the payer’s policies regarding drug pricing.
Common Scenarios
1A pharmacy submits a claim for a drug provided to a patient under the 340B program, and the remittance advises no refund due to the claim's eligibility.
→ The N907 remark code clarifies that the claim is eligible for 340B pricing, which results in no refund being issued as the ceiling price is lower than the maximum fair price.
2A healthcare provider bills for a medication provided to a low-income patient, resulting in a remittance with an adjustment indicating no refund due to 340B eligibility.
→ The presence of N907 signifies that the claim is recognized as 340B-eligible and indicates that the pricing rules apply, thus explaining the adjustment.
3A hospital submits a claim for outpatient drug administration and receives a remittance with the N907 remark alongside an adjustment reason code regarding pricing.
→ In this case, the N907 remark code indicates that the claim is subject to the 340B pricing restrictions, which justifies the lack of a refund due to the lower ceiling price.
What to Do
- Do not attempt to resubmit the claim for a refund, as the N907 indicates that no refund is due.
- Ensure future claims follow 340B pricing guidelines if applicable.
What to Check
- Review the original claim submission to confirm it was billed under the 340B program.
- Check the remittance advice for the accompanying reason code to understand the context of the adjustment.
- Verify the eligibility of the drug and pricing under the Medicare Drug Price Negotiation Program.