N925Remark Code (RARC)Active
N925 Remark Code - Medicare Advantage Payment Denial
The N925 remark code indicates that the Medicare Advantage Organization (MAO) has denied payment responsibility for a service at the time the encounter record was submitted. This denial suggests that the MAO determined it was not liable for the cost of the service provided based on their review at the time of submission.
How It Relates to the Denial
The N925 remark code typically accompanies claim adjustment reason codes that denote denial due to non-responsibility for payment by the MAO. The combination of these codes signals that the service was reviewed and found not payable under the terms of the Medicare Advantage plan at the time of submission.
Common Scenarios
1A provider submitted a claim for a routine office visit under a Medicare Advantage plan, but the remittance returned with an adjustment reason code indicating denial for lack of eligibility.
→ In this case, the N925 remark code indicates that the MAO reviewed the encounter and determined it had no payment responsibility for that office visit at the time the claim was submitted.
2A claim for a diagnostic test was sent to a Medicare Advantage plan, and the remittance shows a denial with a reason code related to lack of coverage.
→ The appearance of the N925 remark code here means the MAO found that it was not responsible for payment for the diagnostic test based on the details provided when the claim was submitted.
3A physical therapy service was billed to a Medicare Advantage organization, and the claim was denied due to a reason code indicating non-coverage for the service.
→ The N925 remark code clarifies that the MAO assessed the claim and concluded it had no payment obligation for the physical therapy service at the time the encounter record was processed.
What to Do
- Review the accompanying claim adjustment reason code for further details on the denial.
- Consider appealing the denial if you believe the service should have been covered under the patient's plan.
- Ensure that future claims include accurate information that aligns with the MAO's coverage policies.
What to Check
- The patient's eligibility and coverage details for the date of service.
- The specific plan benefits document for the Medicare Advantage plan.
- Any prior authorizations or referrals that may have been required for the service.