N916Remark Code (RARC)Active
N916 Remark Code - Third Party Payment Responsibility
The N916 remark code indicates that a third party will make payment directly to the provider for covered services, and the provider is expected to reimburse you. This suggests that the adjustment you see is related to a situation where payment responsibility has shifted to another entity.
How It Relates to the Denial
The N916 remark typically accompanies adjustment reason codes that denote a payment shift to a third party, indicating that the service billed is covered under another payer's policy. This combination signals that the provider must handle the reimbursement process directly with the third party.
Common Scenarios
1A provider submitted a claim for a surgical procedure, but the remittance indicates a denial due to coverage under another payer's policy.
→ The N916 remark clarifies that while the claim was denied for payment by the current payer, a third party will pay the provider directly, which necessitates reimbursement to the original billing entity.
2A patient received physical therapy services, and the remittance shows an adjustment where payment is not made due to third-party coverage.
→ In this case, the N916 remark explains that the third party is responsible for payment, and the provider is expected to manage the reimbursement process.
3A claim for diagnostic imaging was submitted, but the remittance shows an adjustment indicating the claim is not payable by the current insurer.
→ The presence of the N916 remark suggests that the imaging services are covered by another entity, and the provider should prepare for direct payment from that third party.
What to Do
- Verify the provider's contract with the third party to understand reimbursement terms.
- Communicate with the provider to ensure they are aware of the third party's payment responsibility.
- Request any necessary documentation from the provider to facilitate the reimbursement process.
What to Check
- Review the claim adjustment reason code that accompanies the N916 remark for additional context.
- Check the patient's insurance details to confirm the third party's coverage for the services rendered.
- Look at the provider's agreement with the third party for specifics on payment and reimbursement procedures.