Skip to main content

N215 Remark Code: Secondary Can't Require Primary Decision

N215 is an alert stating that a payer providing supplemental or secondary coverage may not require a claims determination from the primary payer for this service as a condition of making its own decision. The secondary plan should process the service on its own merits.

Quick facts

Code
N215 (RARC N215)
Status
Active In use since April 1, 2004; last modified April 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): Often used with other adjustments on coordination of benefits claims. N215 explains the rule, not an amount.
  • CO (Contractual Obligation): Any contractual reductions still apply as usual.
Official description
Alert: A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determination.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N215 means

Normally a secondary payer waits for the primary payer’s decision before calculating what it owes. N215 flags a service where that wait is not allowed. Under the rules governing the plan, the supplemental or secondary payer has to make its own determination without first demanding the primary’s decision.

The alert appears on coordination of benefits remittances and is informational; it does not by itself indicate payment or denial.

What to do

  1. Note that, for this service, the secondary payer should not hold the claim for a primary determination.
  2. If the secondary plan has processed the claim, post the result as usual.
  3. If another remark on the same claim asks for primary information, check whether it applies to a different service line.
  4. If you later see a denial for missing primary information on a service covered by this rule, cite N215 when asking for reprocessing.

The details of which services fall under this kind of rule differ by program and state, so confirm with the payer. For general COB background, see eligibility and COB denials.

Codes that may appear with N215

  • OA-22 (This care may be covered by another payer per coordination of benefits.): Care may be covered by another payer; N215 notes the secondary cannot wait on that payer's decision for this service.
  • OA-23 (The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)): The impact of prior payer adjudication on the payment.
  • N36 (Claim must meet primary payer's processing requirements before we can consider payment.): The contrary situation: the claim must meet the primary payer's requirements before the payer will consider it.
  • MA04 (Secondary payment cannot be considered without the identity of or payment information from the primary payer.): Secondary payment cannot be considered without primary payer information.

N215 FAQ

When does N215 apply?

When a rule, often in law or program regulation, prevents a secondary or supplemental payer from insisting on the primary payer's determination first for a particular service. Which services qualify depends on the program.

Do I need to send the primary EOB?

For services covered by this rule, the secondary should not require it as a precondition. For other services on the same claim, normal COB rules still apply.

What if the secondary plan still denies for missing primary info?

Point to the N215 alert and the applicable rule in a reconsideration request, and ask the payer to process the service independently.