N917Remark Code (RARC)Active
N917 Remark Code - Alternative Refund Amount Explanation
The N917 remark code indicates that an alternative refund amount has been calculated due to the maximum fair price being lower than the 340B ceiling price. This code supplements an adjustment already detailed by a Claim Adjustment Reason Code, providing additional context specific to the pricing structure under the Medicare Drug Price Negotiation Program.
How It Relates to the Denial
The N917 remark code typically accompanies adjustment reason codes related to drug pricing adjustments, specifically within the context of the Medicare Drug Price Negotiation Program. The combination signals that the adjustment made reflects a calculated refund amount based on the 340B ceiling price requirements.
Common Scenarios
1A provider billed for a drug under the Medicare Drug Price Negotiation Program, and the remittance shows a reduction in payment due to pricing adjustments.
→ In this scenario, the N917 remark code clarifies that the reduced payment reflects an alternative refund amount calculated because the maximum fair price is below the 340B ceiling price.
2A pharmacy submitted a claim for a medication that falls under the 340B program, and the payment received was less than expected, with N917 noted on the remittance advice.
→ The presence of N917 indicates that the payment adjustment relates to the calculated maximum fair price being lower than what the 340B ceiling price allows, which the payer is enforcing.
3During a claim review, a provider notices that a drug claim payment was adjusted, and the N917 remark appears on the remittance advice detailing the adjustment.
→ The N917 remark tells the provider that the adjustment was made based on an alternative refund amount due to the specific pricing structure of the Medicare Drug Price Negotiation Program.
What to Do
- Verify the claim against the pricing guidelines under the Medicare Drug Price Negotiation Program.
- Calculate any potential adjustments to ensure compliance with the 340B ceiling price requirements.
- Communicate with the payer if further clarification on the refund calculation is needed.
What to Check
- Review the original claim submission for accuracy in drug pricing.
- Consult the pricing documentation related to the 340B program.
- Check the remittance for the specific Claim Adjustment Reason Code that accompanies the N917 remark.