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N137 Remark Code: Provider May Appeal for the Member

N137 is an appeal-rights alert. A provider acting for the member may appeal to the payer. If the coverage decision involves an urgent condition for which care has not yet been given, the provider may instead file a complaint with the state insurance regulator without first appealing to the payer.

Quick facts

Code
N137 (RARC N137)
Status
Active In use since October 31, 2002; last modified April 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): Informational. The alert explains appeal routes; liability is determined by the other codes on the claim.
  • PR (Patient Responsibility): When the decision left the member with a balance, N137 describes how the provider can challenge it on the member's behalf.
Official description
Alert: The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N137 means

N137 describes two routes for challenging a coverage decision. The normal route is an appeal to the payer, which a provider can file for the member. The second route is available when the decision concerns an urgent condition and care has not been given yet: the provider can go directly to the state insurance regulator with a complaint, skipping the payer’s appeal step.

It is most useful on pre-service denials, where timing matters.

What to do

  1. Decide whether the matter is urgent and whether care is still pending.
  2. For standard cases, file an appeal with the payer, with the member’s authorization if required.
  3. For urgent, pre-service cases, consider both an expedited appeal with the payer and a complaint to the state regulator.
  4. Document the clinical urgency in a short physician letter to support either route.

The authorization and referral denials guide covers the pre-service decisions where this alert most often appears.

Codes that may appear with N137

  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Not medically necessary, a decision often challenged on the member's behalf.
  • CO-197 (Precertification/authorization/notification/pre-treatment absent.): Precertification or authorization absent, which can arise before urgent care is delivered.
  • CO-39 (Services denied at the time authorization/pre-certification was requested.): Services denied at the time authorization was requested, a pre-service decision the alert applies to.
  • N136 (Alert: To obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at (602) 912-8444 or…): An Arizona-specific pointer to state consumer assistance for appeals.
  • N210 (Alert: You may appeal this decision.): A general statement that the decision may be appealed.

N137 FAQ

Does the provider need the member's permission to appeal?

N137 describes the provider acting on the member's behalf, which usually requires the member's authorization or designation. Check the payer's form and state rules.

What counts as urgent here?

A condition needing prompt care that has not been delivered yet, where waiting for a standard appeal could harm the patient. State law defines urgency for this purpose.

How do I reach the state regulator?

The remark says the address can be obtained from the State Insurance Regulatory Authority, usually the state department of insurance.