N911Remark Code (RARC)Active
N911 Remark Code - Manufacturer Reimbursement Delay
The N911 remark code indicates that the claim cannot be reimbursed by the manufacturer until the Part D plan corrects the prescription drug event data submitted to CMS for validation of the maximum fair price. This code supplements a claim adjustment reason code, providing additional context for the denial or delay in payment related to drug pricing under the Medicare Drug Price Negotiation Program.
How It Relates to the Denial
The N911 remark typically accompanies claim adjustment reason codes that indicate a payment delay or denial due to issues with data submitted to CMS. This combination signifies that the Part D plan must address specific data inaccuracies before reimbursement can proceed.
Common Scenarios
1A pharmacy submitted a claim for a Part D drug, but the payment was delayed due to an issue with the data reported to CMS.
→ The N911 remark code in this context is signaling that the manufacturer will not reimburse until the Part D plan rectifies the prescription drug event data.
2A healthcare provider received an 835 remittance showing a denial for a medication due to pricing validation issues under the Medicare program.
→ The presence of the N911 remark indicates that the denial is tied to the need for corrected data from the Part D plan before any payment can be made.
3A patient was billed for a Part D prescription, but the claim review returned a denial with an adjustment reason code related to pricing issues.
→ The N911 remark clarifies that the reimbursement is pending because the necessary drug event data has not been corrected and validated by the Part D plan.
What to Do
- Confirm that the Part D plan is aware of the issue and is taking steps to correct the prescription drug event data.
- Do not resubmit the claim until the Part D plan resolves the data discrepancies with CMS, as this will not lead to reimbursement until addressed.
What to Check
- The claim submission details to ensure accurate data was provided initially.
- The communication with the Part D plan regarding the status of the prescription drug event data corrections.
- The adjustment reason code on the remittance to understand the primary reason for the claim denial or delay.