N103Remark Code (RARC)Active
N103 Remark Code - Patient in Custody Denial Explained
The N103 remark code indicates that the patient was in custody of a government authority when the service was provided. As a result, the payer does not reimburse for services rendered to individuals in custody unless specific state or local laws hold the individual personally responsible for their healthcare costs and allow for collection efforts.
How It Relates to the Denial
N103 typically accompanies claim adjustment reason codes that denote non-payment due to the circumstances of the patient’s custody status. This combination signals that the service may not be covered under the payer's policy due to the patient's legal situation.
Common Scenarios
1A provider submitted a claim for a medical service rendered to a patient who was incarcerated at the time of service. The remittance returned with a denial for the service.
→ The N103 remark clarifies that the payer does not cover services provided to individuals in custody, pointing to the patient's status as the reason for the denial.
2A claim for a surgical procedure was submitted for a patient who was held under federal custody when the procedure occurred. The remittance included an adjustment for non-payment.
→ The N103 remark indicates that the payer's policy excludes coverage for services rendered to individuals in custody, which justifies the adjustment made on the claim.
3A healthcare provider billed for a consultation service for a patient who was in state custody. The remittance showed a denial with an accompanying adjustment reason code.
→ The N103 remark suggests that the payer does not reimburse for services rendered to those in custody, thereby explaining the denial linked to the patient's status.
What to Do
- Do not resubmit the claim; the payer will not cover the services rendered under the described circumstances.
- If applicable, consider pursuing collection from the appropriate government authority if state or local laws permit.
What to Check
- Review the patient’s custody status at the time of service to confirm the circumstances of care.
- Check state or local laws regarding liability for healthcare costs for individuals in custody.
- Verify the adjustment reason code accompanying the N103 remark for additional context on the denial.