N558Remark Code (RARC)Active
N558 Remark Code - Service Area Non-Payable Explanation
The N558 remark code indicates that the claim or service is not payable because it falls outside the payer's designated service area. The payer expects the claim to be submitted to the appropriate payer or plan that covers the area where the equipment was received.
How It Relates to the Denial
The N558 remark code typically accompanies a claim adjustment reason code that reflects a denial based on service area restrictions. Together, they signal that the claim was submitted to the wrong payer based on the location of service.
Common Scenarios
1A provider submitted a claim for durable medical equipment (DME) services rendered to a patient who lives outside the payer's service area. The remittance advice shows the N558 remark code along with a corresponding adjustment reason code indicating a denial.
→ In this case, the N558 remark is clarifying that the claim cannot be paid because it is not under the payer's service area, and the provider must file the claim with the correct payer that covers the patient's location.
2A claim for physical therapy services was denied with an adjustment reason code due to a service area limitation. The remittance includes the N558 remark code, indicating the reason for the denial.
→ Here, the N558 remark is emphasizing that the services billed are outside the payer's authorized area, necessitating a resubmission to the appropriate payer.
3An outpatient hospital submitted a claim for outpatient services provided to a patient who resides in a different region than the payer's service area. The remittance came back with an N558 remark.
→ This suggests that the N558 remark is informing the hospital that the claim is not payable because the services were provided in a location not covered by the payer.
What to Do
- Resubmit the claim to the correct payer or plan covering the service area where the equipment was received.
- Verify the patient's address to ensure the correct payer is identified for future claims.
What to Check
- The patient's service area eligibility documentation to confirm the correct payer.
- The claim submission records to identify where the claim was initially sent.
- The payer's service area guidelines to ensure compliance with submission rules.