N423Remark Code (RARC)Active
N423 Remark Code - Retroactive Adjustment Explanation
The N423 remark code indicates that the claim payment was adjusted retroactively due to a non-standard program set by the payer. This means that the payment amount you received reflects changes made after the claim was originally processed, based on specific criteria or programs that are not standard across all payers.
How It Relates to the Denial
The N423 remark typically accompanies a Claim Adjustment Reason Code that explains the initial adjustment. Together, they signal that the payer has made a retroactive change based on unique program rules that may not apply universally to other claims.
Common Scenarios
1A hospital submitted a claim for inpatient services, and the payment received was lower than expected. The remittance included a CARC indicating a payment adjustment, along with the N423 remark.
→ In this case, the N423 remark clarifies that the lower payment was due to a retroactive adjustment linked to a specific non-standard program of the payer.
2A provider billed for a procedure under a specific contract, but the payment was adjusted downward later with the N423 remark appearing on the remittance advice.
→ Here, the N423 remark suggests that the adjustment was made because the payer applied a retroactive policy change related to a non-standard program.
3An outpatient service claim was submitted and later received a payment correction with the N423 remark noted on the remittance advice.
→ The presence of the N423 remark indicates that the payment correction was a result of a retroactive adjustment due to the payer's specific program rules.
What to Do
- Review the explanation provided by the accompanying Claim Adjustment Reason Code to understand the specific adjustment details.
- Contact the payer for clarification on the non-standard program referenced if the adjustment is unclear or seems incorrect.
What to Check
- The remittance advice for the accompanying Claim Adjustment Reason Code to see the initial reason for the payment adjustment.
- Any contract terms or agreements with the payer that might outline non-standard program rules or criteria.
- The claim submission details to verify the accuracy of the billed services against the adjusted payment.