N665Remark Code (RARC)Active
N665 Remark Code - Unlicensed Provider Services Not Reimbursable
The N665 remark code indicates that the services billed were provided by an unlicensed provider, which makes them non-reimbursable. This remark supplements a Claim Adjustment Reason Code to clarify that the lack of a valid provider license is the reason for the denial of payment.
How It Relates to the Denial
The N665 remark typically accompanies adjustment reason codes related to provider eligibility or billing errors. The combination signals that the payment denial stems from the provider's licensing status, which is a requirement for reimbursement.
Common Scenarios
1A physical therapy claim was submitted for services performed by a therapist who does not hold a valid state license. The remittance shows a denial with the accompanying reason code indicating a billing error.
→ The N665 remark clarifies that the denial is due to the therapist's unlicensed status, which is why reimbursement is not possible.
2A claim for a surgical procedure performed by a physician who is not licensed in the state where the service was rendered was submitted. The remittance returned with a denial reason code for provider eligibility.
→ The presence of the N665 remark indicates that the denial is specifically because the physician was unlicensed, reinforcing the adjustment reason provided.
3A dental claim was denied after a service was rendered by an assistant who lacked proper licensure. The remittance included a reason code for non-covered services.
→ The N665 remark suggests that the services are deemed non-reimbursable because they were performed by an unlicensed provider, as explained by the accompanying reason code.
What to Do
- Verify the provider's licensing status to confirm whether they are authorized to provide the billed services.
- If the provider is licensed, gather documentation to support the claim and prepare to appeal the denial.
- If the provider is unlicensed, consider alternative billing options or services that can be provided by a licensed professional.
What to Check
- The provider's license information to ensure compliance with state regulations.
- The claim submission to confirm that the correct provider information was included.
- The payer's policy on reimbursement for services rendered by licensed versus unlicensed providers.