N91Remark Code (RARC)Active
N91 Remark Code - Services Not Included in Appeal Review
The N91 remark code indicates that the services billed are not part of the appeal review process. This means the payer is clarifying that certain services included in the claim were excluded from consideration during the appeal.
How It Relates to the Denial
The N91 remark typically accompanies a Claim Adjustment Reason Code that reflects a denial or adjustment due to services not being reviewed in an appeal. This combination signals that while an appeal was made, some services were not evaluated for coverage or payment.
Common Scenarios
1A provider submitted an appeal for a denied claim that included multiple services. The remittance returned with a denial adjustment for one service and the N91 remark code.
→ In this case, the N91 remark indicates that the payer did not review the specific service associated with the N91 during the appeal process, suggesting it may need separate consideration.
2A provider received an adjustment on a claim for a surgical procedure that included post-operative care. The remittance shows a denial for the surgical procedure with the N91 remark attached.
→ Here, the N91 remark indicates that the post-operative care services were not included in the appeal review, which signals that the provider may need to address those services separately.
3A claim for a diagnostic test was appealed due to initial denial. The remittance response includes an adjustment for the test and an N91 remark.
→ This suggests that while the appeal was considered, the N91 remark signifies that the specific diagnostic test was not evaluated during that review, indicating further action may be necessary.
What to Do
- Review the services billed to determine which were not included in the appeal review.
- Consider submitting a new appeal or additional documentation for the services referenced by the N91 code.
- Clarify with the payer what specific services were excluded from the review.
What to Check
- The original claim submission to identify all services billed.
- The appeal documentation submitted to see what was included in the review.
- The remittance advice for corresponding Claim Adjustment Reason Codes that provide further context.