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N146 Remark Code: Missing Screening Document

N146 means a screening document the payer requires for this claim was missing. Until the screening form or record is received, the payer will not process or pay the service.

Quick facts

Code
N146 (RARC N146)
Status
Active In use since October 31, 2002; last modified August 1, 2004.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim is held or denied for missing documentation. The provider fixes it by supplying the screening document, not by billing the patient.
Official description
Missing screening document.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N146 means

Some programs require evidence that a screening took place before they will pay. The screening might establish that a patient needs a certain level of care, qualifies for a program, or has been assessed for specific needs. N146 tells you that the document proving that screening did not arrive with the claim or is not in the payer’s file.

When the document arrives but has problems, payers use N243 instead. N146 means it was not there at all.

Common causes

  • The screening was done, but the form was never sent or uploaded to the payer.
  • The claim did not indicate that an attachment was coming, so the payer did not wait for it.
  • An attachment was sent without the claim number or control number, and the payer could not match it.
  • The screening was performed by another entity and never forwarded to the billing provider.

How to fix it

  1. Find out exactly which screening the payer requires for this service, using the billing manual or provider line.
  2. Obtain the completed document, from your records or from the agency that performed it.
  3. Send it using the payer’s attachment process, referencing the claim, or resubmit the claim with the attachment indicator filled in.
  4. Confirm receipt before the claim’s resolution deadline.

How to prevent it

List the services that require screening documents for each payer and add a check to intake or admission. Store the completed form with the account so billing can attach it automatically. The missing information guide covers attachment tracking in general.

Codes that may appear with N146

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information needed for adjudication; N146 names the screening document.
  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment or other documentation is required to adjudicate this claim.
  • CO-163 (Attachment/other documentation referenced on the claim was not received.): An attachment referenced on the claim was not received.
  • N243 (Incomplete/invalid/not approved screening document.): The screening document was received but was incomplete, invalid, or not approved.
  • N80 (Missing/incomplete/invalid prenatal screening information.): Flags missing or invalid prenatal screening information.
  • N175 (Missing review organization approval.): Missing review organization approval, another pre-service document requirement.

N146 FAQ

What is a screening document?

A form or assessment some payers or programs require before paying certain services, such as a pre-admission screening for nursing facility placement in some Medicaid programs. The payer's billing manual defines what it requires.

How do I send it?

Follow the payer's attachment process: electronic attachment, fax or upload with a cover sheet, or mail, referencing the claim number. On an 837, indicate that an attachment is being sent.

What if the screening was never done?

Then the service may not qualify. Contact the payer about whether a late screening can be accepted.