N803Remark Code (RARC)Active
N803 Remark Code - Claim Submission Responsibility
The N803 remark code indicates that the responsibility for submitting the claim for the rendered service lies with the Contracted Medical Group or Hospital. This suggests that the provider who received the payment is not the one responsible for billing the payer for the service provided.
How It Relates to the Denial
The N803 remark code typically accompanies adjustment reason codes that indicate a claim was denied or adjusted due to improper billing responsibility. This combination signals that the claim should have been submitted by a different entity, such as a medical group or hospital under contract.
Common Scenarios
1A provider billed for a surgical procedure performed on a patient, but the remittance shows an adjustment for the claim with the N803 code.
→ This means that the surgical group or hospital, rather than the individual provider, is responsible for submitting the claim to the payer.
2A facility submitted a claim for inpatient services, but the payment remittance returned an adjustment with the N803 remark code.
→ The N803 code indicates that the hospital is the entity responsible for the submission of the claim, not the facility that provided the services.
3A physician's office receives a remittance for a consultation service that includes the N803 remark code along with a denial adjustment.
→ In this case, the remark informs the office that the claim submission responsibility lies with a contracted medical group associated with the hospital.
What to Do
- Review the contract terms with the medical group or hospital to confirm billing responsibilities.
- Coordinate with the contracted medical group or hospital to ensure they submit the claim appropriately.
What to Check
- The contract agreement between the provider and the medical group or hospital.
- Claim submission policies of the payer to understand the correct billing entity.
- Documentation of the services rendered to verify which entity should bill for the service.