N598Remark Code (RARC)Active
N598 Remark Code - Health Care Policy Coverage is Primary
The N598 remark code indicates that the health care policy in question is considered the primary coverage for the claim. This means that the payer has determined that another policy should cover the costs before any secondary insurance is applied to the claim.
How It Relates to the Denial
The N598 remark code typically accompanies an adjustment reason code that indicates a claim denial or reduction based on primary versus secondary coverage. This combination signals that the payer is clarifying the order of coverage responsibilities.
Common Scenarios
1A provider submitted a claim for a procedure performed on a patient with multiple insurance policies, including a primary and a secondary plan. The remittance shows a denial for the claim with the accompanying reason code indicating that the primary coverage was not billed first.
→ The N598 remark code implies that the payer has identified the health care policy as primary, suggesting that the provider needs to bill this primary insurer before resubmitting to the secondary.
2A patient received services covered under two different health plans, and the claim was submitted to the secondary payer without first billing the primary insurer. The remittance returned a denial with a reason code for coverage issues along with the N598 remark code.
→ Here, the N598 remark code indicates that the secondary payer is clarifying that the primary policy should have been billed first, and any adjustments made reflect this coverage hierarchy.
3A facility billed for a patient's inpatient stay, and the remittance indicates a payment adjustment due to coverage issues. The accompanying reason code cites a denial for not having billed the primary insurer, and N598 appears as a remark.
→ The N598 remark code is reinforcing the need to address the primary coverage before any payment can be made, indicating a need for correct billing practices.
What to Do
- Verify that the primary insurance was billed before any secondary claims were submitted.
- Ensure that the claim is resubmitted to the correct primary insurer if it was initially submitted to the secondary insurance.
- Check for any necessary documentation to support the primary coverage when resubmitting the claim.
What to Check
- The claim submission history to confirm the order in which insurers were billed.
- The patient's insurance policy documents to identify the primary payer.
- The remittance advice for the specific adjustment reason code that accompanies the N598 remark code.