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N197 Remark Code: Subscriber Must Update Insurance Info

N197 means the payer needs the subscriber to contact it directly and update insurance information, most often coordination of benefits details about other coverage. The provider generally cannot make this update on the member's behalf.

Quick facts

Code
N197 (RARC N197)
Status
Active In use since February 25, 2003.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Some payers assign the charge to the patient until the subscriber updates the information, which prompts the member to act.
  • CO (Contractual Obligation): Other payers deny under CO while waiting. Either way, the claim can often be reprocessed once the update is made.
Official description
The subscriber must update insurance information directly with payer.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N197 means

When a payer’s records about other insurance are uncertain or out of date, it may stop paying until the member confirms the situation. N197 says that update has to come from the subscriber, meaning the policyholder, rather than from the provider’s billing office. Most often, it’s triggered by a coordination of benefits questionnaire that went unanswered.

It frequently appears with CARC 22 or CARC 227.

Common causes

  • The plan’s annual COB questionnaire was never returned.
  • A data match suggested the member has other coverage, and the plan needs the member to confirm or deny it.
  • The subscriber added or dropped a plan (for example after a job change) without telling this insurer.
  • A dependent’s coverage status changed and the subscriber has not updated it.

What to do

  1. Tell the patient, in plain language, that their insurer is waiting to hear from them about other coverage.
  2. Give them the member services number and suggest they ask specifically about coordination of benefits.
  3. Create a follow-up task to check the claim after the patient says they have called.
  4. If the update reveals another primary plan, bill that plan and send this payer the primary remittance.
  5. Once resolved, request reprocessing if the payer does not do so automatically.

For a broader look at coverage problems, see eligibility and COB denials.

How to prevent it

Ask about other coverage at every registration and include a short reminder on intake paperwork that insurers periodically ask members to confirm other insurance. A prompt from the front desk often gets patients to answer before claims are affected.

Codes that may appear with N197

  • OA-22 (This care may be covered by another payer per coordination of benefits.): The payer believes other coverage may be primary and needs the subscriber to confirm or correct it.
  • CO-227 (Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.): Information requested from the patient or insured was not provided.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Information needed for adjudication is missing; only the member can supply it.
  • N191 (The provider must update insurance information directly with payer.): The same update requirement, but directed at the provider.
  • N179 (Additional information has been requested from the member.): The payer has requested information from the member and will reconsider on receipt.

N197 FAQ

Why can't the provider update the information?

Many payers require the subscriber to attest to other coverage, since it concerns the member's contract. Some payers do accept provider input, but N197 indicates this one wants the subscriber.

How does the patient update their information?

Usually by calling member services, completing an online coordination of benefits questionnaire, or returning a form the plan mailed. The member ID card lists the phone number.

What happens after the subscriber updates?

Some payers reprocess affected claims automatically. Others need the provider to request reprocessing or resubmit. Check claim status a few weeks later.

Can I bill the patient in the meantime?

If the payer assigned the amount to PR, you may be able to, depending on your policy and contract. Many practices wait a set period to give the patient time to respond.