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N615 Remark Code: APTC Enrollee in Premium Grace Period

N615 is an alert that the patient receives advance payments of the premium tax credit and is in the three-month grace period for non-payment of premium. Under 45 CFR 156.270, the plan must pay appropriate claims for the first month and may pend claims for the second and third months.

Code: N615 (RARC N615)
Status: Active In use since July 15, 2013; last modified March 1, 2017.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: OA (Other Adjustment): Claims in months two and three may be pended rather than paid or denied. The amount is undetermined.
CO (Contractual Obligation): Some issuers report grace-period holds under CO. Treat the balance as pending.
Official description: Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N615 means

Marketplace enrollees who get advance premium tax credits have a three-month grace period if they stop paying their share of premiums. Federal rules (45 CFR 156.270) require the plan to pay claims for services in the first month and allow it to pend claims for the second and third months. N615 tells you the patient is in that grace period. It often pairs with CARC 257.

What to do

Check the date of service against the grace-period months. N616 and N617 identify which month applies.
Tell the patient their coverage is at risk and pended claims may be denied.
Track pended claims and watch for reprocessing or denial after the grace period ends.
Verify eligibility before future visits for this patient. See eligibility denials.

Codes that may appear with N615

OA-257 (The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements.): The claim disposition is undetermined during the Exchange premium grace period.

N616 (Alert: This enrollee is in the first month of the advance premium tax credit grace period.): The enrollee is in the first month of the grace period.
N617 (This enrollee is in the second or third month of the advance premium tax credit grace period.): The enrollee is in the second or third month of the grace period.
N618 (Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.): The claim will be reprocessed automatically if premiums are paid.

N615 FAQ

Who does this grace period apply to?

People enrolled in a Qualified Health Plan through a Health Insurance Marketplace who receive advance premium tax credits.

What happens if the patient doesn't pay by the end of the grace period?

Coverage can be terminated effective the end of the first grace month, and pended claims from months two and three may be denied.

Should I collect from the patient now?

Consider your financial policy and state rules. Many practices tell the patient about the grace period and collect or set up payment if claims are later denied.

Important: read before using this information

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