N6Remark Code (RARC)Active
N6 Remark Code - Payment Limit Under FEHB Law
The N6 code indicates that the payment is limited by federal law, specifically referencing the Federal Employees Health Benefits (FEHB) program. This remark informs the provider that the payer cannot reimburse more than what Medicare would have permitted if the patient had Medicare Part A and/or Part B coverage.
How It Relates to the Denial
The N6 remark code typically accompanies adjustments made under claim adjustment reason codes related to payment limits due to Medicare regulations. This combination signals that the allowed amount is capped based on Medicare's payment guidelines.
Common Scenarios
1A provider billed for a surgical procedure for a patient enrolled in the FEHB program. The remittance advice returned an adjustment indicating a reduced payment.
→ The N6 code clarifies that the reduction is due to the payer's obligation to adhere to Medicare's payment standards, thus limiting the reimbursement to what Medicare would allow.
2A facility submitted a claim for inpatient care under the FEHB program, and the payment was lower than expected.
→ The appearance of the N6 code suggests that the facility's payment was adjusted downward in line with Medicare's allowable amounts, reflecting the payer's compliance with federal law.
3A claim for outpatient services was billed, and the remittance included a note about payment limitations citing the N6 remark.
→ This indicates that the payer has restricted the payment amount based on Medicare's criteria, as required by FEHB law, impacting the total reimbursement.
What to Do
- Review the claim to ensure billing aligns with Medicare's allowable amounts.
- Verify that the services billed fall under the coverage guidelines specified by the payer's policies regarding Medicare limitations.
What to Check
- Consult the Medicare fee schedule for the services provided to understand the allowable amounts.
- Review the patient's eligibility and benefits under the FEHB program to confirm coverage limits.
- Check the claim adjustment reason code accompanying the N6 remark for additional context on the payment adjustment.