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N588 Remark Code: Patient Told Insurer Not to Pay

N588 means the payer did not pay because the patient instructed it not to pay medical claims or bills. The payer is following the patient's direction, so the provider must work with the patient on how the charges will be paid.

Quick facts

Code
N588 (RARC N588)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Because the patient directed non-payment, the amount is typically treated as the patient's responsibility, subject to state law and your agreements.
  • OA (Other Adjustment): Some payers report it as an other adjustment while the patient's instruction stands.
Official description
The patient has instructed that medical claims/bills are not to be paid.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N588 means

N588 is unusual: the payer is not denying coverage on its own. The patient told the insurer not to pay medical bills, and the insurer is honoring that instruction. It is seen mostly on auto and other property and casualty claims, where the injured person may have some control over how a limited benefit is used.

It may appear with CARC P6 or CARC 227.

Possible reasons

  • The patient wants to save a limited benefit for other providers or for lost wages.
  • The patient disputes the bill or the treatment.
  • The patient plans to use a different coverage for the care.
  • An attorney advised the patient during a pending claim.

What to do

  1. Contact the patient to learn the reason and whether the instruction applies to all your bills or only some.
  2. Review your assignment of benefits. If the patient assigned benefits to you, discuss the conflict with the payer and, if needed, your legal advisor.
  3. Bill other coverage if the patient wants the care paid by a health plan, checking that plan’s coordination rules.
  4. Resubmit or request reprocessing if the patient withdraws the instruction.
  5. Follow your financial policy and state rules before billing the patient.

How to prevent surprises

For accident-related care, obtain a signed assignment of benefits at intake and explain to patients how their benefit limits work, so decisions about the benefit are discussed with you before they are made.

Codes that may appear with N588

  • CO-P6 (Based on entitlement to benefits.): Based on entitlement to benefits as directed by the insured.
  • CO-227 (Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.): Information or direction needed from the patient is outstanding.
  • N582 (Benefits suspended pending the patient's cooperation.): Benefits suspended until the patient cooperates.
  • N587 (Policy benefits have been exhausted.): Policy benefits have been exhausted.
  • N585 (Benefits are no longer available based on a final injury settlement.): Benefits ended because of a final injury settlement.

N588 FAQ

Why would a patient tell an insurer not to pay?

Reasons vary. A patient may want to preserve a limited auto medical benefit for other bills, may be disputing a charge, or may prefer to use other coverage. Ask the patient.

Can the patient reverse the instruction?

Usually yes, by contacting the insurer. Once they do, ask the payer whether it will reprocess or whether you need to resubmit.

Can I bill the patient?

It depends on state law, especially for auto no-fault claims, and on any assignment of benefits. Review both before sending a statement.