N174Remark Code (RARC)Active
N174 Remark Code - Patient Liability Limited Explained
The N174 remark code indicates that the billed service, procedure, equipment, or bed is not covered by the payer, but the patient's financial responsibility is limited to the amounts specified in the adjustments categorized under 'PR'. This means that although the service is not covered, the patient is not liable for the full billed amount, only for the amounts outlined in the related adjustments.
How It Relates to the Denial
The N174 remark code typically accompanies a Claim Adjustment Reason Code that signifies a denial due to lack of coverage. When paired with the accompanying reason code, it clarifies the patient's liability in relation to the denied service.
Common Scenarios
1A claim for a non-covered procedure is submitted, and the payer denies it, citing lack of coverage. The remittance includes an adjustment showing a patient responsibility amount under group 'PR'.
→ In this scenario, the N174 remark code informs the biller that while the procedure is not covered, the patient will only be responsible for the amounts listed in the adjustments under 'PR', rather than the entire billed amount.
2A claim for durable medical equipment (DME) is billed, but the payer determines it is not a covered service. The remittance shows a partial adjustment for patient liability.
→ Here, the N174 remark code indicates that the DME is not covered, yet the patient’s financial liability is limited to the amounts indicated in the 'PR' group adjustments.
3A claim for an inpatient bed is denied because it is not a covered service. The remittance advice includes adjustments that specify patient responsibility amounts.
→ In this case, the N174 remark code clarifies that the bed is not covered, but the patient is only liable for the amounts stated in the relevant 'PR' adjustments.
What to Do
- Review the adjustments under group 'PR' on the remittance to determine the patient's liability amounts.
- Do not attempt to appeal the denial based solely on coverage, as the service is clearly stated as not covered.
- If applicable, inform the patient of their limited financial responsibility as indicated in the adjustments.
What to Check
- The claim adjustment reason code associated with the N174 remark to understand the basis for the denial.
- The remittance advice details to see the specific amounts listed under group 'PR'.
- The patient's benefits and coverage policy to confirm the service's non-covered status.