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N199 Remark Code: Payment Change From Payer Audit

N199 means the payer has approved an additional payment or a recoupment on this claim as a result of a review or audit that the payer itself started. The adjustment reflects the audit's outcome rather than a new claim decision.

Code: N199 (RARC N199)
Status: Active In use since February 25, 2003; last modified August 1, 2006.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: CO (Contractual Obligation): A recoupment under CO reduces what the provider was paid; an additional payment may appear as a negative adjustment. Neither changes patient billing by itself.
OA (Other Adjustment): Some payers report audit-related reversals and corrections under OA.
PR (Patient Responsibility): If the audit changes cost-sharing, patient amounts may be revised, which may require a refund or new statement.
Official description: Additional payment/recoupment approved based on payer-initiated review/audit.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N199 means

Payers review paid claims after the fact through internal audits, data analytics, and targeted reviews. When those reviews result in a change, N199 marks the adjustment. The change can go either way: the payer may pay more because it found it underpaid, or it may take money back because it found an overpayment.

The remark typically comes with CARC 216 or CARC 129, and the remittance often shows a reversal of the original payment followed by a corrected adjudication.

Common causes

Pricing or fee schedule errors found during a payer audit.
Coding reviews that changed the payable level or disallowed a service.
Coordination of benefits findings that altered who should have paid.
Medical record reviews after a records request.

What to do

Match the remittance to any audit letter or records request you received. The letter explains findings; the remit just applies them.
Post the reversal and corrected payment carefully so the account balance reflects the net change.
If the adjustment is a recoupment you dispute, file an appeal within the stated time limit with supporting documentation.
If patient amounts changed, update statements and issue refunds if needed.
Look for patterns. Repeated audit findings often reveal a coding or documentation issue worth fixing.

How to prevent it

Regular internal coding audits catch many problems before payers do. Monitoring your remittances for audit-driven adjustments over time, for example with the ERA Analyzer, helps show which services attract payer reviews.

Codes that may appear with N199

CO-216 (Based on the findings of a review organization or the payer's findings.): The adjustment is based on the findings of a review organization or the payer's own review.
CO-129 (Prior processing information appears incorrect.): Prior processing information appears incorrect and the payer has corrected it.
CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): A recoupment may follow a finding that services were not medically necessary.

N432 (Alert: Adjustment based on a Recovery Audit.): Alert that the adjustment is based on a Recovery Audit.
N421 (Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.): Payment resulted from a retroactive adjustment due to a review organization decision.
N10 (Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.): Adjustment based on the findings of a review organization, consultant, or manual review.

N199 FAQ

How do I know whether N199 is money in or money out?

Look at the adjustment amounts and the claim payment on the remittance. A reversal and re-adjudication pair often appears, and the net difference shows whether you gained or lost.

Can I dispute a recoupment flagged with N199?

Yes, if you disagree with the audit findings. The audit letter or payer's provider manual explains the appeal process and deadlines.

Do I need to refund the patient?

Possibly, if the audit reduced patient responsibility and the patient already paid. Review the revised PR amounts.

Important: read before using this information

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