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N219 Remark Code: Paid on Previous Payer's Allowance

N219 means this payer based its payment on the allowed amount set by the previous payer, typically the primary, rather than on its own fee schedule. It is a coordination of benefits explanation, not a denial.

Quick facts

Code
N219 (RARC N219)
Status
Active In use since August 1, 2004.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): Adjustments reflecting the prior payer's adjudication, often with CARC 23, appear here. They are not patient responsibility.
  • CO (Contractual Obligation): Any amount above the prior payer's allowance that this payer will not recognise may be a contractual write-off, depending on your agreements.
  • PR (Patient Responsibility): Remaining cost-sharing after both payers, if any, is the patient's responsibility.
Official description
Payment based on previous payer's allowed amount.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N219 means

When a claim is processed as secondary, the payer has to decide how much it owes on top of what the primary paid. Some payers calculate that from their own fee schedule. Others anchor to the allowed amount the primary payer set. N219 tells you this payer used the second approach.

It usually appears on secondary claims with CARC 23 (impact of prior payer adjudication). The payment is final unless the COB data was wrong.

Common causes

  • The payer’s coordination method bases its liability on the primary’s allowance.
  • A Medicaid program limits payment to the primary’s allowed amount under state rules.
  • The primary’s allowance was lower than this payer’s fee schedule, so it controlled.

What to do

  1. Confirm the primary payer’s allowed amount, payment, and adjustments on the primary remittance.
  2. Compare them with what the secondary claim reported. If they differ, submit a corrected claim with the right COB data and resubmission code 7.
  3. Post the secondary payment with its OA and CO adjustments, and bill the patient only for PR amounts.
  4. If you believe your contract requires a different calculation, raise it with the payer’s provider relations team.

For more on secondary billing, see eligibility and COB denials.

How to prevent it

Build secondary claims from posted primary remittances so the prior payer’s allowance is transmitted exactly, and keep a note of each secondary payer’s coordination method so expected payments are realistic.

Codes that may appear with N219

  • 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, the usual companion that shows what the primary allowed and paid.
  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): Charge exceeds the allowed amount, here tied to the previous payer's allowance.
  • N9 (Adjustment represents the estimated amount a previous payer may pay.): The adjustment represents the estimated amount a previous payer may pay.
  • N408 (This payer does not cover deductibles assessed by a previous payer.): This payer does not cover deductibles assessed by a previous payer.
  • MA04 (Secondary payment cannot be considered without the identity of or payment information from the primary payer.): Secondary payment cannot be considered without the primary payer's information.

N219 FAQ

Why would a secondary payer use the primary's allowance?

Many plans and state Medicaid programs limit their payment so that the combined total does not exceed a certain amount, often the lower of the two payers' allowances. Rules vary by plan.

Can I bill the patient the difference?

Only the amounts reported under PR. If the payer or contract limits the total to the prior payer's allowance, the rest is usually not billable.

What if the primary allowance on the claim was wrong?

Correct the COB information to match the primary remittance and submit a corrected claim.