N215Remark Code (RARC)ActiveInformational Alert
N215 Remark Code - Claims Determination Alert
The N215 remark code indicates that a payer offering supplemental or secondary coverage does not need a claims determination from the primary payer to make its own claims determination for the billed service. This means that the secondary payer can process the claim without waiting for the primary payer's decision.
What This Alert Tells You
As an alert remark code, N215 is not associated with any specific adjustments or reason codes. It serves to inform billers about the payer's policy regarding supplemental or secondary coverage and the claims process.
Common Scenarios
1A provider submits a claim to a secondary payer after the primary payer has been billed, but the primary has not yet processed the claim.
→ The presence of the N215 remark code indicates that the secondary payer can proceed with its claims determination without waiting for the primary payer's response.
2A facility bills for a service under a secondary insurance plan and receives an 835/ERA that includes the N215 alert.
→ The N215 alert informs the billing staff that the secondary payer is not requiring a primary payer's claim determination to process the service.
3A patient has both primary and secondary insurance, and the secondary payer processes a claim immediately after submission, showing the N215 code.
→ This means the secondary payer is acting in accordance with the policy outlined by the N215 remark code, which allows them to make their own determination without the primary's input.
What to Do
- Do not take any action to resubmit the claim based on this alert.
- Expect the secondary payer to process the claim independently of the primary payer's decision.
What to Check
- Review the claim submission to ensure all necessary information was included for the secondary payer.
- Check the patient's insurance policy to confirm they have supplemental or secondary coverage.
- Confirm that the service billed is eligible for secondary processing without primary determination.