N128Remark Code (RARC)Active
N128 Remark Code - Prior to Coverage Adjustment
The N128 remark code indicates that the amount referenced in the remittance advice is the portion of the allowance that applies to services rendered prior to the patient's coverage effective date. This means that the billed services were provided before the insurance plan began covering the patient, leading to a reduction in the payment amount.
How It Relates to the Denial
N128 typically accompanies adjustment reason codes that denote a reduction in payment due to the timing of service relative to the patient's coverage. The combination of N128 with these reason codes signals that the allowance is adjusted based on prior coverage issues.
Common Scenarios
1A patient received physical therapy services on March 1, 2023, but their insurance coverage started on April 1, 2023. The claim was submitted but received a payment that was lower than expected.
→ The N128 remark code suggests that the lower payment reflects the portion of the allowance that corresponds to services provided before the patient was covered by the insurance plan.
2An outpatient surgery was performed on January 15, 2023, while the patient's new policy began on February 1, 2023. Upon receiving the remittance, the provider notices a significant reduction in the allowed amount.
→ The presence of the N128 remark code indicates that the reduction is due to the allowance being adjusted for services that were rendered before the patient's coverage was active.
3A patient had an MRI performed on December 20, 2022, but their insurance coverage took effect on January 5, 2023. The remittance shows an amount that is less than the billed charge, with the N128 remark included.
→ The N128 remark code clarifies that the adjustment reflects the allowance for the MRI that was performed prior to the effective date of the patient's insurance coverage.
What to Do
- Verify the patient's coverage effective date to confirm the timing of services.
- Review the claim details to ensure that the services were billed correctly according to the patient's coverage status.
- Consider resubmitting the claim with appropriate documentation if the services should be covered based on a different plan or if there was an error.
What to Check
- The patient's insurance policy document for effective dates.
- The claim submission details to ensure accurate billing dates.
- The remittance advice for the accompanying reason code that provides the primary basis for the adjustment.