Skip to main content

N192 Remark Code: Patient Is Medicaid or QMB

N192 is an alert that the patient is a Medicaid beneficiary or a Qualified Medicare Beneficiary (QMB). For QMB patients, providers generally may not bill the patient for Medicare deductibles, coinsurance, or copayments, even if the remittance shows those amounts.

Quick facts

Code
N192 (RARC N192)
Status
Active In use since February 28, 2003; last modified July 1, 2020.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Cost-sharing may still be reported under PR, but for QMB patients federal rules generally bar collecting it from the patient. Bill Medicaid or the state program instead where applicable.
  • CO (Contractual Obligation): Contractual adjustments remain the provider's write-off as usual.
Official description
Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N192 means

The QMB program is a Medicaid benefit that helps low-income Medicare beneficiaries with premiums and cost-sharing. N192 flags that the patient is enrolled in Medicaid or is a Qualified Medicare Beneficiary, so the remaining balance should not be treated like an ordinary patient balance.

The PR amounts on the remittance still show what Medicare applied to deductible and coinsurance. For QMB patients, federal rules generally prohibit providers from collecting those amounts from the beneficiary, whether or not the provider accepts Medicaid.

What to do

  1. Mark the account so patient statements are suppressed for Medicare cost-sharing.
  2. If the claim crossed over to Medicaid, wait for that remittance; if not, bill the state program directly where you are enrolled.
  3. Write off any cost-sharing Medicaid does not pay, following your state’s rules and your compliance guidance.
  4. Refund any QMB cost-sharing already collected from the patient.

Because rules vary between states and program categories, confirm details with your Medicaid agency. See eligibility and COB denials for more on dual-eligible billing.

Codes that may appear with N192

  • PR-1 (Deductible Amount): A deductible was applied; with N192 that amount generally cannot be collected from a QMB patient.
  • PR-2 (Coinsurance Amount): Coinsurance applied; for a QMB, pursue Medicaid rather than the patient.
  • PR-3 (Co-payment Amount): A copayment applied, subject to the same QMB billing protection.
  • MA07 (Alert: The claim information has also been forwarded to Medicaid for review.): Alert that the claim was also forwarded to Medicaid for review.
  • MA13 (Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.): Warns of penalties for billing patients for amounts not reported under PR.
  • OA-209 (Per regulatory or other agreement.): The provider cannot collect the amount from the patient but may bill a subsequent payer.

N192 FAQ

Can I bill a QMB patient for their coinsurance?

Generally no. Federal law prohibits billing Qualified Medicare Beneficiaries for Medicare cost-sharing. You may be able to bill the state Medicaid program, which may pay some or none of it depending on state rules.

What if the patient has already paid?

Review your records and refund amounts that should not have been collected. Consult your compliance team about the specifics.

Does N192 change the Medicare payment?

No. It is informational and does not change what Medicare paid. It tells you how to handle the remaining balance.