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N475 Remark Code: Missing Completed Referral Form

N475 means the completed referral form is missing. The plan requires a referral form, filled out in full by the referring provider, for this service, and it did not receive a completed one.

Quick facts

Code
N475 (RARC N475)
Status
Active In use since July 1, 2008.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Under most network contracts the specialist absorbs the amount when a required referral is not on file. The patient is not billed unless the plan and contract allow it.
  • PR (Patient Responsibility): Some plans assign the charge to a member who obtained care without a required referral. Check the plan's rules first.
Official description
Missing completed referral form.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N475 means

Referral-based plans make the primary care provider the gatekeeper for specialty and some other services. Some of those plans use a specific referral form that the referring provider must complete and send. N475 says the plan did not receive a completed form for this service.

It commonly appears with CARC 288 (referral absent) or CARC 252.

Where the process breaks

The referral depends on two offices working together, and it usually stalls at a handoff:

  • The specialist’s office assumed the primary care office sent it.
  • The primary care office completed the form but faxed it to the specialist only, not the plan.
  • The form was started in the plan’s portal but never submitted.
  • The patient was told they needed a referral but scheduled before it was issued.

What to do

  1. Search the plan’s system for any referral linked to the patient and your provider for these dates.
  2. Contact the referring office and ask for a completed form. Confirm the specialty, provider, and number of visits it covers.
  3. Ask the plan about retroactive referrals, since policies differ and some do not accept them at all.
  4. Submit the completed form and request reprocessing, or send a corrected claim with the referring provider in box 17 and NPI in 17b and resubmission code 7.
  5. Appeal if the referral was completed before the service and the plan failed to record it.

How to prevent it

Make “referral on file” a hard stop at scheduling for referral-based plans, and check the plan’s portal rather than relying on a faxed copy. The authorization and referral denials guide covers a full front-end workflow.

Codes that may appear with N475

  • CO-288 (Referral absent): Referral absent.
  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment is required; N475 specifies the completed referral form.
  • CO-243 (Services not authorized by network/primary care providers.): Services not authorized by network or primary care providers.
  • N476 (Incomplete/invalid completed referral form.): A completed referral form was received but was incomplete or invalid.
  • N489 (Missing referral form.): A closely related remark stating the referral form is missing.
  • N286 (Missing/incomplete/invalid referring provider primary identifier.): The referring provider's primary identifier on the claim is missing or invalid.

N475 FAQ

How is N475 different from N489?

Both point to a missing referral. N475 stresses a completed form, so payers may use it when their own referral form must be filled out and returned. Handle both the same way: get the referral on file.

Who completes the referral form?

The referring provider, usually the patient's primary care provider. The specialist's office often helps by requesting it.

Can the patient bring the form?

Sometimes. Some plans accept a paper form from the patient; others require the referral to be entered in the plan's portal by the referring office.