N789Remark Code (RARC)Active
N789 Remark Code - Clinical Trial Not Covered
The N789 remark code indicates that the clinical trial associated with the claim is not a covered benefit under the payer's policy. This remark supplements the adjustment already specified by the accompanying reason code, clarifying that coverage for the clinical trial is denied.
How It Relates to the Denial
The N789 remark typically accompanies adjustment reason codes that indicate a denial of payment related to clinical trials. The combination signals to the biller that the service billed falls outside of the payer's benefit coverage for clinical trials.
Common Scenarios
1A provider submitted a claim for a patient enrolled in a clinical trial, billing for related services. The remittance returned with an adjustment reason code indicating denial of payment.
→ The N789 remark clarifies that the payer does not cover services rendered as part of the clinical trial, confirming the denial outlined by the accompanying reason code.
2A facility billed for laboratory tests performed on a patient participating in a clinical trial. The remittance shows a denial for these services with an adjustment reason code.
→ The N789 remark indicates that the payer considers these laboratory tests as part of a clinical trial, which is not a covered benefit, reinforcing the denial from the accompanying reason code.
3A claim was filed for a surgical procedure linked to a clinical trial protocol. The remittance includes a denial adjustment reason code.
→ The presence of the N789 remark signifies that the payer does not provide coverage for the surgical procedure when it relates to a clinical trial, as indicated by the accompanying reason code.
What to Do
- Review the payer's clinical trial coverage policy to confirm non-coverage details.
- Consider alternative billing options if the service is critical and the patient is eligible for other benefits.
- Communicate with the patient regarding the denial and potential financial responsibility.
What to Check
- The payer's policy on clinical trial coverage to understand exclusions.
- The patient's eligibility for benefits that may cover related services outside the clinical trial.
- The claim submission details to ensure accurate coding and documentation were provided.