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N493 Remark Code: Doctor's First Report of Injury Missing

N493 means the workers' compensation carrier did not receive the Doctor's First Report of Injury, the initial report the treating provider files after first examining an injured worker. Bills for the case may be held or denied until the report is on file.

Quick facts

Code
N493 (RARC N493)
Status
Active In use since July 1, 2008.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The bill is held or denied for missing documentation the provider is responsible for. Injured workers generally cannot be billed for compensable care.
Official description
Missing Doctor First Report of Injury.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N493 means

This is a workers’ compensation remark. When a provider first treats someone for a job-related injury or illness, most state systems require a first report from the treating doctor. It records how the injury happened according to the worker, the findings, the diagnosis, the initial treatment plan, and usually the worker’s ability to return to work. California’s Doctor’s First Report of Occupational Injury or Illness is a well-known example, but forms and rules differ by state.

N493 tells you the carrier cannot find that report. Carriers often use it to open or verify the medical side of the claim, so the bill for the first visit, and sometimes later visits, can stall without it.

Common causes

  • The bill was sent but the first report was filed separately, late, or not at all.
  • The report went to the employer rather than the carrier or its bill review vendor.
  • The report was filed but lacked the claim number, so it was never linked.
  • The practice treated the visit as group health and only later learned it was work related.

How to fix it

  1. Confirm the claim number, carrier, and adjuster with the employer or carrier.
  2. Locate or complete the first report using the jurisdiction’s required form.
  3. Send it to the carrier by the method it requires, with the claim number on every page, and keep proof of submission.
  4. Rebill or request reconsideration of the held bills once the report is on file, following state billing rules.
  5. Check state filing obligations. Some jurisdictions also require the report to be sent to a state agency.

How to prevent it

Flag work injuries at check-in and route the first visit through a workers’ comp checklist: carrier, claim number, adjuster, and the first report completed the same day. Attach the report to the first bill whenever the carrier allows it.

Codes that may appear with N493

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): A required attachment is missing; the remark names it as the first report of injury.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The bill lacked information needed to adjudicate it.
  • CO-P1 (State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation.): A state-mandated property and casualty requirement, explained by this remark.
  • N494 (Incomplete/invalid Doctor First Report of Injury.): The first report was received but was incomplete or invalid.
  • N495 (Missing Supplemental Medical Report.): A later supplemental report is missing, rather than the initial one.
  • N625 (Missing/Incomplete/Invalid Workers' Compensation Claim Number.): The workers' compensation claim number is missing or invalid.

N493 FAQ

When is the Doctor's First Report due?

Deadlines are set by each state's workers' compensation rules and are often short, counted from the first examination. Check the jurisdiction's regulations or the carrier's instructions.

Does every state use the same form?

No. Many states have their own first report form or required data elements, and some accept electronic filing. Use the form the jurisdiction requires.

Can I bill the injured worker while the report is missing?

Generally no. Workers' compensation rules in most states protect injured workers from billing for accepted work injuries. Fix the documentation with the carrier instead.