N104Remark Code (RARC)Active
N104 Remark Code - Claims Jurisdiction Denial Explained
The N104 remark code indicates that the claim or service is not payable under the payer's claims jurisdiction area. This means that the claim was processed by the wrong Medicare contractor, as it falls outside their designated area for coverage.
How It Relates to the Denial
The N104 remark code typically accompanies adjustment reason codes that indicate a denial based on jurisdictional issues. The combination of these codes signals to the biller that the claim needs to be directed to the appropriate Medicare contractor for processing.
Common Scenarios
1A provider submitted a claim for a service rendered to a patient in a state outside the payer's jurisdiction. The remittance returned with an adjustment reason code indicating that the claim was denied for jurisdiction issues, along with the N104 remark code.
→ The N104 remark clarifies that the claim cannot be paid because it was submitted to the wrong Medicare contractor, highlighting the need to verify jurisdiction.
2A claim for physical therapy services was denied with an adjustment reason code stating that the service is not covered. The N104 remark code appeared on the remittance advice.
→ This suggests that the service is indeed not covered under the payer's jurisdiction, and the N104 remark indicates the need to find the correct contractor for this claim.
3A hospital submitted a claim for a surgical procedure performed on a patient who resides in a different geographic area than the facility. The remittance response included an adjustment reason code for non-payment along with the N104 remark.
→ The N104 remark indicates the claim is not payable because it is out of the contractor's jurisdiction, suggesting that the biller should identify the proper contractor for processing.
What to Do
- Verify the patient's jurisdiction and determine the correct Medicare contractor for the claim.
- Resubmit the claim to the appropriate Medicare contractor identified through the CMS website.
- Ensure that all relevant documentation is included with the new submission to avoid further denials.
What to Check
- The patient's residency information to confirm the jurisdiction area.
- The claims submission details to ensure it was sent to the correct contractor.
- The CMS website for the correct Medicare contractor based on the service location.