Skip to main content

N691 Remark Code: Reversal After Patient Appeal

N691 is an alert that the payer reversed its earlier processing because the patient, or member, filed an appeal. The claim is reprocessed based on the outcome of that member appeal, which can change the payment and the patient's balance.

Quick facts

Code
N691 (RARC N691)
Status
Active In use since November 1, 2013; last modified March 14, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The original payment and adjustments are reversed. New contractual adjustments on the reprocessed claim reflect the appeal outcome.
  • PR (Patient Responsibility): The appeal may have changed what the patient owes, so compare the new PR amounts with what you have billed the patient.
Official description
Alert: This reversal is due to a patient submitted appeal.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N691 means

Patients have their own appeal rights, separate from the provider’s. A member might appeal a denied service, a network determination, or how cost-sharing was applied. When the plan decides in the member’s favor, it may reverse the original claim and process it again. N691 labels that reversal.

The biggest practical impact is usually on the patient’s account. A service that was the patient’s responsibility may now be covered, or cost-sharing may change.

What to do

  1. Post the reversal and the reprocessed claim together, so the net payment is clear.
  2. Recalculate the patient balance using the new PR amounts. Stop collection activity on amounts that are no longer owed.
  3. Refund the patient promptly if they paid more than the new responsibility.
  4. Note the appeal in the account history, including what changed, so staff can answer the patient’s questions.
  5. Check other claims for the same patient and issue. A member appeal can apply to a series of related visits.

If a reprocessed claim reduces your payment, contact the payer to understand why before deciding whether to appeal on your own behalf.

Codes that may appear with N691

  • CO-64Deactivated (Denial reversed per Medical Review.): Denial reversed per medical review, which can accompany a successful member appeal.
  • N690 (Alert: This reversal is due to a provider submitted appeal.): The reversal was triggered by the provider's appeal instead.
  • N695 (Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.): A reversal to correct patient financial responsibility.
  • N720 (Alert: The patient overpaid you.): Alert that the patient overpaid and may be owed a refund.

N691 FAQ

Why didn't I know the patient appealed?

Members can appeal on their own without involving the provider. The payer may or may not notify you before reprocessing.

Can a patient appeal reduce my payment?

Usually a member appeal aims to increase coverage, but any reprocessing can change amounts. Review the reprocessed claim in full.

What if the patient already paid a balance that is now covered?

Refund the patient according to the new PR amounts and your refund policy, and any applicable state rules on timing.