N766Remark Code (RARC)Active
N766 Remark Code - Co-Payment Not Covered
The N766 remark code indicates that the payer does not cover a co-payment that was assessed by a previous payer. This remark supplements a claim adjustment reason code, clarifying that the current payer is not responsible for the co-payment amount billed due to prior payer's assessment.
How It Relates to the Denial
Typically, the N766 remark accompanies adjustment reason codes related to payment denials or reductions where a co-payment from a prior payer is involved. This combination signals that the current payer is denying responsibility for the co-payment based on prior payment arrangements.
Common Scenarios
1A hospital billed for a surgical procedure where a co-payment was applied by the primary insurance. The remittance came back with an adjustment reason code indicating a denial for the co-payment amount.
→ In this case, the N766 remark clarifies that the current payer will not cover the co-payment assessed by the primary payer, reinforcing the denial of that specific amount.
2A specialist's office submitted a claim for a patient who had received care, and a co-payment was already collected by the first insurance. The remittance from the secondary payer included a reason code for adjustment along with the N766 remark.
→ Here, the N766 remark indicates that the secondary payer is not liable for the previously assessed co-payment and will not provide reimbursement for it.
3A patient received treatment in an outpatient facility, and the claim was denied for the co-payment amount due to a previous payer's action. The remittance included both a denial reason code and the N766 remark.
→ The N766 remark points out that the current payer is not responsible for the co-payment assessed by the previous payer, confirming the denial of that portion of the claim.
What to Do
- Review the previously paid claim from the first payer to confirm the co-payment amount assessed.
- Ensure that the billed amount reflects only what is covered under the current payer's policy without including the previous co-payment.
- If applicable, inform the patient about their financial responsibility regarding the co-payment.
What to Check
- The remittance advice details where the adjustment reason code is provided.
- The payment history from the previous payer to verify the co-payment assessment.
- The patient account records to see if the co-payment was previously collected.