N923Remark Code (RARC)Active
N923 Remark Code - Payment Responsibility Determination
The N923 code indicates that the claim was not denied, and the Medicare Advantage Organization (MAO) has determined the payment responsibility. This remark clarifies that the payer has assessed the claim and has made a decision regarding who is responsible for payment, rather than rejecting the claim outright.
How It Relates to the Denial
The N923 remark typically accompanies a Claim Adjustment Reason Code that reflects a payment responsibility determination. This combination signals that while the claim is not denied, the payment may be shared or adjusted based on the MAO's assessment.
Common Scenarios
1A provider billed for a series of outpatient services under a Medicare Advantage plan, and the remittance came back with adjustments for some services but included N923.
→ In this case, N923 indicates that the services were assessed, and the MAO has clarified how the payment responsibility is allocated without denying the claim.
2A hospital submitted a claim for a patient stay under a Medicare Advantage plan, receiving a payment with the N923 remark noted alongside other adjustment codes.
→ Here, N923 signifies that the MAO reviewed the claim and determined the responsibility for payment, indicating the claim is not denied but may be subject to specific payment adjustments.
3An office visit claim was submitted and returned with several adjustments, including N923, indicating payment responsibility was determined by the MAO.
→ This remark shows that the claim was not outright denied; instead, the MAO has made a determination on how much will be covered and what the patient's financial responsibility may be.
What to Do
- Review the payment responsibility determination provided by the MAO.
- Ensure that the claim is appropriately adjusted based on the MAO's assessment.
- Communicate with the patient regarding any outstanding balance they may owe.
What to Check
- The Claim Adjustment Reason Code that accompanies N923 for additional context.
- The remittance advice for specific payment details outlined by the MAO.
- The patient's benefit plan document to verify coverage details and responsibilities.