N919Remark Code (RARC)Active
N919 Remark Code - Out-of-Pocket Maximum Met
The N919 remark code indicates that the family or member's out-of-pocket maximum has been reached. This means that the billed services may not result in further patient financial responsibility for the remainder of the benefit period, as the maximum limit has been satisfied.
How It Relates to the Denial
Typically, the N919 remark code accompanies adjustments related to patient liability or cost-sharing. It provides additional context to the accompanying reason code, clarifying that no further payment is required from the patient for the services rendered due to the out-of-pocket maximum being met.
Common Scenarios
1A family received multiple medical services throughout the year, and a claim for a recent office visit was submitted. The remittance returned with an adjustment indicating that the patient owes nothing for this visit.
→ The N919 remark code indicates that the patient's out-of-pocket maximum has been met, meaning they will not incur additional costs for this visit.
2An individual has been receiving ongoing treatment and has consistently been billed for copayments. After submitting a claim for a recent procedure, the remittance shows a zero balance due from the patient.
→ The N919 remark code shows that the patient's out-of-pocket maximum has been satisfied, eliminating any further patient payment responsibility for this procedure.
3A patient was billed for several services over the course of the year, and a claim for a recent hospitalization was processed. The remittance shows that the patient has no remaining balance due.
→ The N919 remark code confirms that the family's out-of-pocket maximum has been reached, which is why there is no further payment required from the patient for the hospitalization.
What to Do
- No action is necessary if the patient has reached their out-of-pocket maximum. Confirm the zero balance due.
What to Check
- The patient's benefit summary to verify the out-of-pocket maximum details.
- The claim adjustment reason code for any additional context regarding the payment adjustment.
- The patient's payment history to ensure accurate tracking of out-of-pocket expenses.