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N52 Remark Code: Patient Not in Your Managed Care Plan

N52 means the patient was not enrolled in the billing provider's managed care plan on the date of service. The claim was sent to a plan that did not cover the patient that day, so it will not pay.

Quick facts

Code
N52 (RARC N52)
Status
Active In use since January 1, 2000.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The provider is responsible for billing the correct plan. The patient is generally not billed while another payer may cover the service.
  • PR (Patient Responsibility): If the patient had no applicable coverage on that date, the service may become the patient's responsibility, subject to any program rules.
Official description
Patient not enrolled in the billing provider's managed care plan on the date of service.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N52 means

Managed care plans pay for their own enrolled members. N52 is a plan telling you the patient on this claim was not its member on the date of service. The patient may belong to another managed care plan, a fee-for-service program, or have no coverage at all for that date.

N52 is often paired with CARC 109 (send to the correct payer), CARC 31, or CARC 27.

Common causes

  • The patient changed plans, and registration still had the old plan.
  • A Medicaid member was assigned to a different managed care organization.
  • The patient’s enrollment had not started yet or had ended before the service date.
  • The claim was sent to the wrong payer ID for a plan with several product lines.
  • The service date on the claim was entered incorrectly.

What to do

  1. Run eligibility for the exact date of service to see which plan, if any, covered the patient.
  2. Bill the correct payer with the patient’s ID for that plan, following its authorization and network rules.
  3. Check timely filing for the new payer, since the clock may already be running.
  4. Correct the date if it was entered wrong, and send a corrected claim to the original plan.
  5. Talk to the patient if no coverage existed, and follow any program rules on patient billing.

How to prevent it

Verify eligibility at every visit, not just the first one, especially for Medicaid managed care members, whose plan assignment can change. Save the eligibility response with the encounter for proof. For a structured checklist, read eligibility and COB denial prevention.

Codes that may appear with N52

  • CO-109 (Claim/service not covered by this payer/contractor.): The claim is not covered by this payer and should be sent to the correct payer.
  • CO-31 (Patient cannot be identified as our insured.): The patient cannot be identified as the payer's insured.
  • PR-27 (Expenses incurred after coverage terminated.): The expenses were incurred after the patient's coverage ended.
  • N30 (Patient ineligible for this service.): The patient is covered but ineligible for this particular service.
  • N216 (We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.): The patient is not enrolled in this portion of the benefit package.
  • CO-242 (Services not provided by network/primary care providers.): Services were not provided by network or primary care providers.

N52 FAQ

Why would a patient switch plans without telling us?

Medicaid members can be reassigned between managed care plans, and people change coverage during open enrollment or with a job change. Patients often do not realize their plan changed.

If the patient is in fee-for-service Medicaid, can I bill that instead?

If eligibility shows fee-for-service coverage for that date, bill the state program according to its rules. If another managed care plan is responsible, bill that plan.

What if I am not in network with the right plan?

You may still be able to bill, but out-of-network rules, authorization requirements, and payment terms may differ. Contact the plan to ask how to proceed.