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N586 Remark Code: Injured Party Doesn't Qualify

N586 means the payer decided that the injured party does not qualify for benefits under the policy or program. The insurer is not liable for this person's medical bills, so another coverage source needs to be identified.

Quick facts

Code
N586 (RARC N586)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): This payer is not liable for the injured person. The balance should be pursued with other coverage.
  • PR (Patient Responsibility): Some carriers list the amount as patient responsibility; check for other insurance before billing the patient.
Official description
The injured party does not qualify for benefits.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N586 means

Every injury policy defines who can collect benefits. N586 is the general statement that the patient falls outside that definition. Unlike N583, which gives one specific reason (not an occupant of the insured vehicle), N586 doesn’t say why.

It is used mostly on auto, liability, and similar property and casualty claims, and usually appears with CARC P6, P21, or 177.

Common causes

  • The patient isn’t a named insured or household member where the coverage is limited to them.
  • A state-law exclusion applies, for instance to people who owned an uninsured vehicle involved in the accident.
  • The claim was filed under the wrong policy for this person.
  • Relationship or residency facts differ from what the insurer has on record.

What to do

  1. Ask the adjuster for the specific reason the patient does not qualify.
  2. Verify the facts with the patient: their relationship to the policyholder, where they live, and their role in the accident.
  3. Look for the right payer, such as the patient’s own auto policy, another liable carrier, or health insurance.
  4. Support a challenge if the patient disputes the decision, by supplying records the insurer requests.

How to prevent it

When registering an accident patient, ask whose policy the claim is under and how the patient is related to that policyholder. That quick question catches most wrong-policy claims before they are billed. See eligibility and COB denials.

Codes that may appear with N586

  • CO-P6 (Based on entitlement to benefits.): Denied based on entitlement to benefits.
  • CO-P21 (Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP)): Denied under PIP or medical payments rules.
  • CO-177 (Patient has not met the required eligibility requirements.): The patient has not met the required eligibility requirements.
  • N583 (Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.): A specific version: the patient was not an occupant of the insured vehicle.
  • N589 (Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to…): Excluded because the person was operating a vehicle while impaired.
  • N578 (Coverages do not apply to this loss.): None of the policy's coverages apply to the loss.

N586 FAQ

Why would an injured person not qualify?

The policy may define eligible injured people narrowly, such as named insureds, household members, or occupants. Some states also exclude people who, for example, were operating an uninsured vehicle they owned.

Is N586 a final decision?

It is the payer's determination. The patient can challenge it through the insurer's process if they believe they meet the definition.

Should I resubmit?

No, unless facts on the claim were wrong. Resubmitting the same bill will not change an eligibility decision.