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N221 Remark Code: Missing Admitting H&P Report

N221 means the payer needed the admitting History and Physical (H&P) report, the physician's assessment at admission, and did not receive it. Without it, the payer often cannot confirm the admission was medically necessary.

Quick facts

Code
N221 (RARC N221)
Status
Active In use since August 1, 2004.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim or days were denied or held for missing documentation. The facility or provider supplies it; the patient is not liable while this is correctable.
Official description
Missing Admitting History and Physical report.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N221 means

Payers reviewing an inpatient stay usually start with the admitting History and Physical. It records why the patient came in, what the physician found, and why admission was necessary. N221 says the payer asked for or expected that report and did not get it. The remark typically explains CARC 252 or CARC 226.

Common causes

  • A records request was answered with discharge documents only, leaving out the H&P.
  • The H&P was dictated late and was not in the record when the packet was assembled.
  • The admission relied on a pre-admission H&P stored in a separate system that was not included.
  • Records were sent to the wrong payer address or without a claim reference, so they were not matched.

How to fix it

  1. Find the admitting H&P in the chart, including any pre-admission H&P and update note.
  2. Make sure it is signed and dated and matches the admission date on the claim.
  3. Send it through the payer’s attachment or records channel, with the claim number and any request reference.
  4. If the claim was denied rather than held, ask whether sending the H&P will trigger reprocessing or whether a reconsideration request is required.

How to prevent it

Create a standard inpatient records packet for payer requests: H&P, physician orders, progress notes, and discharge summary. Track dictation completion so H&Ps are signed before claims or records packets go out.

Codes that may appear with N221

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment is required; N221 specifies the admitting H&P.
  • CO-226 (Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.): Requested information was not provided; the H&P was part of that request.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Without the H&P, the payer may not be able to establish medical necessity for the admission.
  • N222 (Incomplete/invalid Admitting History and Physical report.): The admitting H&P was received but was incomplete or invalid.
  • M127 (Missing patient medical record for this service.): The patient medical record for the service was missing.
  • N706 (Missing documentation.): Missing documentation in general.

N221 FAQ

What is an admitting History and Physical?

The physician's documented history, examination, assessment, and plan at the time of hospital admission. It is a standard part of the inpatient record.

Who usually receives N221?

Hospitals and other inpatient facilities, especially during utilization or post-payment reviews. Admitting physicians may also see it on professional claims if the payer requests records.

What if the H&P was done before admission?

Many hospitals allow a recent pre-admission H&P with an update note. Send both the H&P and the update so the payer sees the complete picture.