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N237 Remark Code: Incomplete Patient Medical Record

N237 means the medical record sent for this service was incomplete or invalid, so it did not support the claim. The payer received records, but they were missing pages, lacked signatures, or did not cover the service and date billed.

Quick facts

Code
N237 (RARC N237)
Status
Active In use since August 1, 2004.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The service was denied or held because the record did not support it. The provider completes the record submission; the patient is not liable.
Official description
Incomplete/invalid patient medical record for this service.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N237 means

N237 is the general-purpose record remark: the payer asked for or reviewed the patient’s medical record for this service, and what it got was not enough. Unlike codes that name a specific document, N237 covers the record as a whole. It often appears with CARC 252 or CARC 50.

Common causes

  • Only a summary or problem list was sent instead of the note for the date of service.
  • Notes are unsigned, or electronic signatures do not display on the printed copy.
  • The record supports the visit but not the specific service billed, such as a procedure performed during the visit.
  • Orders or test results that justify the service are in a separate system and were left out.
  • Pages are missing or out of order.

How to fix it

  1. Re-read the payer’s request letter to see exactly what was asked for.
  2. Assemble a focused packet: the signed note for the date of service, plus orders, results, and history that support the specific service.
  3. Confirm signatures print on every page that needs them, and number the pages.
  4. Add a short cover letter listing the contents and pointing to the passages that support the service.
  5. Submit through the payer’s reconsideration or records channel with the claim reference.

How to prevent it

Create a records-request workflow with a checklist by service type, and assign one person to assemble and check each packet. Track turnaround so requests aren’t missed. If records denials cluster around particular services, that points to a documentation template worth revisiting. For more on analysing patterns like this, see CARC and RARC denial analysis.

Codes that may appear with N237

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation is required; the record sent was not sufficient.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): The payer could not confirm medical necessity from the record provided.
  • CO-226 (Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.): Requested information from the provider was insufficient or incomplete.
  • M127 (Missing patient medical record for this service.): The patient medical record for this service was missing entirely.
  • N206 (The supporting documentation does not match the information sent on the claim.): The supporting documentation does not match the claim.
  • N205 (Information provided was illegible.): The information provided was illegible.

N237 FAQ

What should a records packet include?

At minimum the signed note for the date of service. Depending on the service, also orders, test results, treatment plans, and history that support medical necessity.

Is sending the entire chart a good idea?

Usually not. Reviewers can miss the key pages. Send what's relevant to the date and service, organised and labelled.

Can I resend records after N237?

Usually yes. Follow the payer's reconsideration or reopening process and reference the claim number.