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N243 Remark Code: Screening Document Not Approved

N243 means a screening document the payer requires for the service was incomplete, invalid, or not approved. A familiar example is the pre-admission screening that many Medicaid programs require before a nursing facility admission.

Quick facts

Code
N243 (RARC N243)
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 required screening did not meet requirements. The provider resolves it; the patient is not liable for the defect.
  • PR (Patient Responsibility): Rare. If the screening found the patient did not qualify and proper notice was given, some programs may assign responsibility elsewhere; check program rules.
Official description
Incomplete/invalid/not approved screening document.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N243 means

Certain services and placements require a screening before they begin. The screening determines whether the patient needs the level of care and whether other services are required. N243 has three possible meanings in one code: the screening document is incomplete, it is invalid, or it was not approved. The remark usually accompanies CARC 272 or CARC 252.

In Medicaid long-term care, pre-admission screening for nursing facility residents is the best-known example. State programs set the forms, who completes them, and how approval is recorded.

Common causes

  • The screening form is missing sections, signatures, or dates.
  • The screening was completed after admission when the program required it before.
  • A second-level evaluation was triggered by the first screening but never completed.
  • The screening outcome did not support the placement or service billed.
  • The approval was recorded under another facility or date range.

How to fix it

  1. Pull the screening documents and any determination letters, and identify which of the three conditions applies.
  2. If the form is incomplete, work with whoever completed it to finish it under the program’s rules.
  3. If an additional evaluation or approval is pending, follow up with the responsible agency.
  4. Once a valid, approved screening is on file, request reprocessing or submit a corrected claim with the original claim number.
  5. If the screening denied the placement, review appeal rights with the program.

How to prevent it

Make completion and approval of required screenings a hard stop in the admission process. Keep copies of screening outcomes in both the clinical record and billing file so they’re available when the claim is reviewed.

Codes that may appear with N243

  • CO-272 (Coverage/program guidelines were not met.): Program guidelines requiring an approved screening were not met.
  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation, the screening document, is required.
  • CO-197 (Precertification/authorization/notification/pre-treatment absent.): The screening functions as a pre-service approval that is absent.
  • N146 (Missing screening document.): The screening document was missing entirely.
  • N80 (Missing/incomplete/invalid prenatal screening information.): Missing or invalid prenatal screening information.

N243 FAQ

What screening documents trigger N243?

Most often pre-admission screenings for nursing facility or long-term care services, such as the federally required screening for serious mental illness and intellectual disability in Medicaid-certified nursing facilities. Other programs have their own screenings.

What does not approved mean here?

The screening was done, but the outcome did not approve the service or placement, or the approving authority has not yet signed off.

Can a screening be completed after admission?

Program rules differ. Some allow limited exceptions, but many require the screening before admission. Check with the state program.