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N212 Remark Code: Processed Under POS Benefit

N212 means the payer processed the charges under the patient's Point of Service (POS) benefit, typically the tier that applies when a member of a POS plan uses care outside the network or without a required referral. Cost-sharing is usually higher under that tier.

Quick facts

Code
N212 (RARC N212)
Status
Active In use since February 1, 2004; last modified March 14, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The member's deductible, coinsurance, or copayment under the POS tier. These are usually higher than in-network amounts and can be billed to the patient.
  • CO (Contractual Obligation): Contractual reductions, if the provider is contracted for the POS product. Non-contracted providers may see different adjustments.
Official description
Charges processed under a Point of Service benefit.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N212 means

Point of Service plans give members a choice at the time of care. Staying in network, usually with a primary care referral, earns the richer benefit level. Going outside the network or skipping the referral is allowed, but benefits drop to the POS tier. N212 tells you the claim was adjudicated at that POS level.

The payment itself is often fine. What changes is how much the plan paid and how much lands on the patient, usually via deductible and coinsurance adjustments under group PR.

Common causes

  • The provider is out of network for this plan.
  • The service required a referral from the patient’s primary care physician and none was on file.
  • The provider participates in the payer’s other products but not this POS network.
  • The referral existed but expired or did not cover this service or visit count.

What to do

  1. Confirm your network status for this specific plan product.
  2. Check whether a referral was required and whether one was on file for the date of service.
  3. If you are in network or a valid referral existed, ask the payer to reprocess at the in-network level, providing the referral number.
  4. If the POS tier was correct, bill the patient the PR amounts and explain why cost-sharing was higher.

For referral workflows, see authorization and referral denials.

How to prevent it

Identify POS plans during eligibility checks and flag whether a referral is needed. Keep referral numbers and visit counts in your scheduling system so staff can see before the visit whether the in-network benefit will apply, and let patients know in advance if it will not.

Codes that may appear with N212

  • PR-1 (Deductible Amount): A deductible, often a separate out-of-network deductible, applied under the POS benefit.
  • PR-2 (Coinsurance Amount): Coinsurance applied at the POS tier.
  • CO-242 (Services not provided by network/primary care providers.): Services were not provided by network or primary care providers, which moves them to the POS tier.
  • CO-243 (Services not authorized by network/primary care providers.): Services were not authorized by network or primary care providers.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Consult plan benefit documents for restrictions on this service.

N212 FAQ

What is a Point of Service plan?

A managed care plan that combines HMO-style in-network care, often with a primary care physician and referrals, with an option to use out-of-network care at higher cost-sharing.

Can N212 be reversed?

If the service should have been processed in-network, for example because a referral was obtained or the provider is in network, contact the payer with proof and ask for reprocessing.

Is N212 a denial?

No. The charges were processed and may have been paid, just under the POS level of benefits.