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N590 Remark Code: Missing Independent Medical Exam

N590 means the payer is missing an independent medical exam (IME) report that describes the cause of the injuries and the medical necessity of the services. It is used mainly on workers' compensation and auto injury claims.

Quick facts

Code
N590 (RARC N590)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Payment is held or denied until the required IME documentation is available. Not billable to the patient while pending.
  • OA (Other Adjustment): Some carriers report the pending IME requirement as an other adjustment.
Official description
Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N590 means

In workers’ compensation and auto injury claims, the insurer may ask an independent physician to examine the patient and give an opinion on what caused the injuries and what treatment is necessary. N590 tells you the payer does not have that IME report, so it cannot yet decide your bill.

This differs from a request for your own records. The missing document comes from an independent examiner, typically arranged by the payer. N590 often appears with CARC 252, CARC 16, or CARC P8.

Common causes

  • The IME has not been scheduled or has not happened yet.
  • The IME took place but the report has not been finalized or linked to the claim.
  • The payer’s rules require an IME before certain treatments or after a certain duration of care.

What to do

  1. Call the adjuster and ask whether an IME is scheduled and when the report is expected.
  2. Ask whether anything from you would help, such as a narrative report or recent progress notes.
  3. Remind the patient to attend any scheduled exam. A missed IME can lead to a denial like N593.
  4. Follow up after the report is issued, and request reprocessing of held bills.
  5. Dispute the findings through the jurisdiction’s process if the IME conclusions are unfavorable and you disagree.

How to prevent delays

For injury cases that are likely to need extended treatment, ask the adjuster early whether an IME will be required, and keep your documentation of causation and necessity strong from the first visit.

Codes that may appear with N590

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment or other documentation is required; N590 names the IME report.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Information needed for adjudication is missing.
  • CO-P8 (Claim is under investigation.): The claim is under investigation.
  • N591 (Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).): Payment was based on an IME or utilization review.
  • N593 (Not covered based on failure to attend a scheduled Independent Medical Exam (IME).): Not covered because the patient did not attend a scheduled IME.
  • N675 (Additional information is required from the injured party.): Additional information is required from the injured party.

N590 FAQ

Who arranges an independent medical exam?

Usually the insurer. It selects an examiner who is not the treating provider and schedules the patient. The treating provider does not perform the IME.

Can the treating provider's records substitute for an IME?

Not when the payer specifically requires an IME, but sending thorough records can support the claim and sometimes reduce the need for one. Ask the adjuster.

What if the IME disagrees with the treating provider?

Many jurisdictions have dispute processes for this. The provider can submit a rebuttal or request review under state rules.