N12Remark Code (RARC)Active
N12 Remark Code - Medicare Enrollment Responsibility
The N12 remark code indicates that the policy in question provides coverage that is supplemental to Medicare. However, it appears that the member is not enrolled in the relevant part of Medicare, which means they are responsible for the payment of the portion of the charge that Medicare would typically cover.
How It Relates to the Denial
The N12 remark code usually accompanies adjustment reason codes that indicate a denial or reduction of payment due to Medicare enrollment issues. This combination signals that the payer recognizes the claim as valid but is denying payment based on the member’s Medicare status.
Common Scenarios
1A claim for a specialist visit is submitted for a patient who has a secondary insurance policy that is supposed to cover costs after Medicare. The remittance shows an adjustment indicating that Medicare coverage is required.
→ The N12 remark suggests that the patient is not enrolled in the necessary part of Medicare, meaning they must pay the amount that Medicare would have covered.
2A patient receives a procedure that is covered under Medicare, but their remittance shows that the claim was denied with a reason code related to lack of Medicare coverage.
→ In this case, the N12 remark informs the biller that the patient’s policy is secondary to Medicare, but since they are not enrolled, they are liable for the costs that Medicare would have otherwise covered.
3A claim for durable medical equipment is submitted with a secondary payer that supplements Medicare. The payment remittance indicates a denial due to Medicare enrollment.
→ The N12 remark indicates that the patient must be enrolled in Medicare for the secondary coverage to apply, and they are responsible for the rejected amount.
What to Do
- Inform the patient of their responsibility for payment due to lack of Medicare enrollment.
- Verify the patient's Medicare enrollment status before resubmitting claims.
- Consider submitting the claim again if the patient enrolls in the applicable Medicare part.
What to Check
- The patient's Medicare enrollment records to confirm their status.
- The claim details to ensure the service is indeed covered by Medicare.
- The policy documents of the supplemental insurance to understand coverage limits.