N216Remark Code (RARC)Active
N216 Remark Code - Service Coverage Not Offered
The N216 remark code indicates that the payer does not provide coverage for the specific type of service billed, or it suggests that the patient is not enrolled in the relevant part of the benefit package. This remark is meant to clarify an adjustment already communicated through a Claim Adjustment Reason Code, guiding you on the coverage status of the service.
How It Relates to the Denial
Typically, the N216 remark code accompanies adjustment reason codes that indicate a denial based on coverage issues. This combination signals to the biller that the service rendered is either not covered or the patient's benefits do not extend to that service type.
Common Scenarios
1A provider submitted a claim for physical therapy services, but the remittance indicates a denial related to coverage.
→ The N216 remark code suggests that the payer does not cover physical therapy services, or the patient does not have those benefits included in their plan.
2A claim for a cosmetic procedure was submitted, and the remittance returned with a denial adjustment reason code for non-covered services.
→ In this case, the N216 remark code reinforces that the payer does not offer coverage for cosmetic procedures, confirming the denial based on the service type.
3A claim for a specialized diagnostic test was denied, and the remittance included an adjustment reason code for lack of coverage.
→ The presence of the N216 remark code indicates that either the test is not covered by the payer or the patient is not enrolled in a plan that includes this test.
What to Do
- Verify the type of service billed against the payer's covered services list.
- Ensure the patient is enrolled in the correct benefit package that includes the service type.
- Consider alternative services that may be covered under the patient's plan.
What to Check
- The patient's benefit plan documentation to confirm coverage specifics.
- The remittance advice for accompanying adjustment reason codes.
- The eligibility response to verify patient enrollment in the benefit package.