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N616 Remark Code: First Month of APTC Grace Period

N616 is an alert that the enrollee is in the first month of the advance premium tax credit grace period. Federal rules require the plan to pay appropriate claims for services during this first month, even though the enrollee is behind on premiums.

Code: N616 (RARC N616)
Status: Active In use since July 15, 2013.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: OA (Other Adjustment): Informational. Any adjustment on the line is explained by the paired CARC, not by the grace period.
PR (Patient Responsibility): Normal cost-sharing, such as deductible or coinsurance, still applies under PR.
Official description: Alert: This enrollee is in the first month of the advance premium tax credit grace period.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N616 means

N616 narrows the grace-period alert to month one. For Marketplace enrollees receiving advance premium tax credits, federal rules require the plan to pay appropriate claims for services in this month. So this claim is processed normally, but the patient is behind on premiums.

What to do

Post the payment normally and apply patient cost-sharing as usual.
Flag the patient’s account. Services in the next two months may be pended (N617), and coverage may end if the premium isn’t paid.
Verify eligibility before upcoming appointments and discuss payment options with the patient if coverage is at risk.

See eligibility and COB denials for verification practices.

Codes that may appear with N616

PR-1 (Deductible Amount): Deductible still applies to first-month claims under the plan's normal rules.
PR-2 (Coinsurance Amount): Coinsurance still applies under the plan's normal rules.

N615 (Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of…): The general alert that the enrollee is in the three-month grace period.
N617 (This enrollee is in the second or third month of the advance premium tax credit grace period.): Second or third month, when claims may be pended.
N698 (Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment…): Alert that a reversal occurred due to non-payment of premiums by the end of the grace period.

N616 FAQ

Can first-month payments be taken back later?

Generally, under the federal rule first-month claims are paid and coverage ends after that month if premiums aren't paid. Watch for any payer-specific reversal codes, and check with the plan if a reversal appears.

Should I warn the patient?

Yes. Letting them know future visits may not be covered helps avoid surprise bills.

Does this apply to employer plans?

No. It applies to Marketplace plans with advance premium tax credits.

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