N219Remark Code (RARC)Active
N219 Remark Code - Payment Based on Previous Payer's Amount
The N219 remark code indicates that the payment made was determined based on the allowed amount set by a previous payer. This means that the current payer adjusted the payment according to what another insurer had already authorized for the same service.
How It Relates to the Denial
The N219 code typically accompanies a Claim Adjustment Reason Code that reflects a payment adjustment related to coordination of benefits. This combination signals that the current payer is acknowledging prior payments and basing their reimbursement on those amounts.
Common Scenarios
1A patient has primary insurance and secondary insurance. The primary insurance pays $200 for a procedure, and the secondary insurance uses this amount to determine their payment.
→ In this scenario, the N219 remark code would clarify that the secondary insurance's payment was influenced by the amount allowed by the primary insurance.
2A claim is submitted to a payer after another payer has processed it. The remittance shows that the current payer has adjusted the payment based on the previous payer's allowed amount.
→ Here, the N219 remark code indicates that the current payer is taking into account the prior payer's decision, which directly affects the payment amount.
3A healthcare provider receives a payment for a service rendered to a patient who had multiple insurance plans. The remittance shows an adjustment based on the prior payer's amount.
→ The N219 remark code in this case signifies that the payment made by the current payer reflects the amount that was already approved by the previous insurer.
What to Do
- Verify that the previous payer's allowed amount is correctly reflected in the claim.
- Ensure that the claim has been processed in the correct order based on coordination of benefits.
- Confirm that the adjustment aligns with the payment policies of the current payer.
What to Check
- The claim adjustment reason code that accompanies N219 on the remittance advice.
- The payment history from the previous payer to confirm allowed amounts.
- The patient's insurance policy details regarding coordination of benefits.