N131Remark Code (RARC)Active
N131 Remark Code - Total Payments Limit Explained
The N131 remark code indicates that the total payments received for a service across multiple contracts cannot exceed the allowable amount set for that service. This remark supplements an adjustment reason code, providing additional context on payment limits related to the contracted amounts.
How It Relates to the Denial
The N131 remark typically accompanies adjustment reason codes that indicate overpayment or payment discrepancies. It signals that the payer has evaluated payments across different contracts and found them to exceed the allowance for the billed service.
Common Scenarios
1A provider bills for a procedure covered under two different contracts with the same payer. The remittance advice shows an adjustment indicating an overpayment for that procedure.
→ The N131 remark clarifies that the total payments from both contracts combined exceeded the allowable amount for the procedure, necessitating a reduction in payment.
2A facility submits a claim for a service that is covered by both a primary and secondary contract with a payer. The remittance reflects a denial for exceeding the payment limit.
→ The N131 remark highlights that the combined payments from the primary and secondary contracts surpassed the maximum allowable for that service, which the payer enforces.
3A specialist bills for a consultation that is part of a bundled payment arrangement with multiple contracts. The remittance shows an adjustment related to the payment received.
→ The N131 remark suggests that the total of all payments received for the bundled service across contracts exceeded the established allowance, prompting an adjustment.
What to Do
- Review the total payments received for the service across all contracts to ensure they are within the allowable limits.
- Consider adjusting future claims to align with the payer's allowed amounts under each contract to prevent overpayments.
- Consult with the payer if clarification is needed on how allowances are determined across multiple contracts.
What to Check
- The contract terms for each agreement with the payer to identify allowable amounts for the service in question.
- The claim adjustment reason code that accompanies the N131 remark to understand the specific adjustments made.
- Payment records for the service to verify the total amount received under all relevant contracts.