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N564 Remark Code: Patient Not Eligible for Pilot

N564 means the payer determined the patient did not meet the inclusion criteria for the demonstration project or pilot program under which the claim was billed. The service may still be payable under the patient's regular benefits if billed that way.

Quick facts

Code
N564 (RARC N564)
Status
Active In use since November 1, 2012.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim was billed under a program the patient did not qualify for. The provider must rebill correctly rather than charge the patient.
  • OA (Other Adjustment): Some payers report the program mismatch as an other adjustment, pending a correctly billed claim.
Official description
Patient did not meet the inclusion criteria for the demonstration project or pilot program.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N564 means

Pilot programs and demonstration projects pay under special rules, but only for patients who fit the program’s inclusion criteria. N564 says this patient did not. The payer is not questioning whether the service was provided; it is saying the claim was billed under the wrong framework for this person.

You will usually see it with CARC 177 (eligibility requirements not met), CARC 132 (demonstration project adjustment), or CARC 272 (program guidelines not met).

Common causes

  • The patient was never enrolled or attributed to the program, but the claim carried program codes or identifiers.
  • The patient’s eligibility changed, for example because of a coverage switch, and they dropped out of the pilot before the date of service.
  • Program criteria were misread, such as a qualifying diagnosis or age range.
  • Claims logic applied pilot billing to every patient at a participating site.

How to fix it

  1. Confirm the program’s inclusion criteria and check them against the patient’s record on the date of service.
  2. If the patient did not qualify, rebill the service under the patient’s standard benefits, removing pilot-specific codes, modifiers, or identifiers. Ask the payer whether it wants a replacement claim (resubmission code 7) or a new one.
  3. If the patient did qualify, contact the payer with proof of enrollment or attribution and request reprocessing.

How to prevent it

Keep a current roster of enrolled or attributed patients for each pilot and check it before applying program billing rules. Do not let a site-wide setting apply demonstration billing automatically.

Codes that may appear with N564

  • CO-177 (Patient has not met the required eligibility requirements.): The patient has not met the required eligibility requirements; N564 ties this to a pilot program.
  • CO-132 (Prearranged demonstration project adjustment.): A demonstration project adjustment.
  • CO-272 (Coverage/program guidelines were not met.): Program guidelines were not met.
  • N30 (Patient ineligible for this service.): A broader statement that the patient is ineligible for this service.
  • N83 (No appeal rights.): No appeal rights because the decision was based on demonstration project provisions.
  • N67 (Professional provider services not paid separately.): Professional services included in a facility payment under a demonstration project.

N564 FAQ

What are inclusion criteria?

The rules that decide who can participate in a pilot, such as diagnosis, enrollment type, attribution to a participating provider, or geography. Each program defines its own.

Should I bill the patient?

No. First determine whether the service can be billed under the patient's standard coverage.

Can I dispute the patient's exclusion?

If you have evidence that the patient met every criterion, ask the payer for its reasoning and follow the program's dispute process. Some demonstrations limit appeal rights.