How To Fix Remark Code M739 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N536 means that the prior payer’s determination of patient responsibility will not be changed, and the service is not covered by the current insurance provider. This code is used to indicate that the claim will not be adjusted or paid by the insurance company.

1. Description

Remark Code N536 indicates that the insurance provider will not change the prior payer’s determination of patient responsibility. The official description states: ‘We are not changing the prior payer’s determination of patient responsibility, which you may collect, as this service is not covered by us.’ This means that the claim will not be adjusted or paid by the current insurance provider.

2. Common Reasons

1. Service not covered by the insurance plan: The specific service or procedure may not be included in the coverage provided by the insurance plan.
2. Patient responsibility determined by prior payer: The prior insurance provider has already determined the patient’s responsibility for the service, and the current insurance provider will not change this determination.
3. Out-of-network provider: If the service was provided by an out-of-network provider, it may not be covered by the current insurance plan.

3. Next Steps

1. Collect patient responsibility: Since the service is not covered by the insurance provider, the patient may be responsible for paying the full cost of the service.
2. Review insurance coverage: It is important to review the insurance plan to understand the coverage and limitations before seeking services.
3. Consider alternative payment options: If the service is not covered by insurance, explore alternative payment options such as payment plans or financial assistance programs.

4. How To Avoid It

1. Understand insurance coverage: Familiarize yourself with the details of your insurance plan, including covered services and any limitations.
2. Verify coverage before receiving services: Contact your insurance provider to confirm coverage for specific services or procedures before receiving them.
3. Choose in-network providers: Whenever possible, choose healthcare providers who are in-network with your insurance plan to maximize coverage.

5. Example Cases

1. Case 1: A claim for a specific medical procedure is denied because it is not covered by the insurance plan, and the patient is responsible for the full cost.
2. Case 2: The prior insurance provider has already determined the patient’s responsibility for a service, and the current insurance provider will not change this determination, resulting in the claim being denied.

Source: Remittance Advice Remark Codes