N924Remark Code (RARC)Active
N924 Remark Code - Pending Payment Determination
The N924 remark code indicates that the payment responsibility for the service has not yet been determined by the Medicare Advantage Organization (MAO) at the time the encounter record was submitted. This means that the claim is pending and has not been denied, but a decision on payment has yet to be made.
How It Relates to the Denial
The N924 remark code typically accompanies a claim adjustment reason code indicating that the claim is still under review or awaiting determination. This combination signals that the claim is not denied, but further action may be pending from the payer's side.
Common Scenarios
1A provider submits a claim for a treatment under a Medicare Advantage plan, and the remittance advice returns with an adjustment indicating the claim is still pending.
→ The N924 remark code clarifies that the claim is not denied but is awaiting a payment responsibility decision from the MAO.
2An outpatient service is billed to a Medicare Advantage plan, and the remittance advice shows the N924 code along with an adjustment reason for pending review.
→ In this case, the N924 remark informs the provider that the payment status is still under review and has not yet been finalized by the MAO.
3A hospital submits an encounter record for a patient under a Medicare Advantage plan, receiving a remittance that includes the N924 remark code.
→ The presence of the N924 remark indicates that the MAO has not yet made a payment determination, meaning the claim remains in a pending status.
What to Do
- Do not take any immediate action regarding the claim; it is pending and not denied.
- Monitor the claim status for updates from the Medicare Advantage Organization regarding payment determination.
What to Check
- Claim submission date to ensure it aligns with the timeframes expected by the payer.
- The accompanying claim adjustment reason code for further context on the pending status.
- Any communication from the Medicare Advantage Organization regarding the claim to anticipate next steps.