Skip to main content

N695 Remark Code: Reversal to Fix Patient Balance

N695 is an alert that the payer reversed the claim because the patient's financial responsibility, such as deductible, coinsurance, or copay, was reported incorrectly the first time. The claim is reprocessed with corrected patient responsibility.

Quick facts

Code
N695 (RARC N695)
Status
Active In use since November 1, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The original patient responsibility amounts are reversed and replaced by corrected PR amounts on the reprocessed claim. The patient may owe more or less than before.
  • CO (Contractual Obligation): Contractual adjustments are reversed along with the original processing and reported again on the reprocessed claim.
Official description
Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N695 means

The payer processed the claim, then realized the patient’s share was off. That often happens because deductibles and out-of-pocket maximums are tracked in accumulators that depend on the order claims arrive. When the payer corrects an accumulator, or finds a benefit setup error, it reverses affected claims and reprocesses them. N695 marks those reversals.

Because the correction is about the patient’s portion, the most important follow-up is on the patient account, not the insurance balance.

What to do

  1. Post the reversal and the reprocessed claim together, noting the change in payer payment and patient responsibility.
  2. Update the patient’s balance to match the new PR amounts.
  3. Refund overpayments promptly under your refund policy and any state requirements.
  4. Send an updated statement if the patient now owes more, with a short explanation, since patients often question a balance that goes up after they paid.
  5. Review related claims. A deductible shift on one claim often affects other claims from the same period.

Staff answering patient calls should know that an N695 reversal means the insurer corrected its own calculation, not that the office made a billing mistake.

Codes that may appear with N695

  • PR-1 (Deductible Amount): Deductible, a frequent source of cost-sharing corrections when accumulators are updated.
  • PR-2 (Coinsurance Amount): Coinsurance recalculated on the reprocessed claim.
  • PR-3 (Co-payment Amount): Co-payment amount corrected on reprocessing.
  • N720 (Alert: The patient overpaid you.): Alert that the patient overpaid and may need a refund.
  • N692 (Alert: This reversal is due to an incorrect rate on the initial adjudication.): A reversal because the initial rate, not the cost-sharing, was wrong.
  • N691 (Alert: This reversal is due to a patient submitted appeal.): A reversal caused by a patient's appeal.

N695 FAQ

Why would cost-sharing be wrong on the first processing?

Claims are often processed out of order, so the deductible may have been applied to one claim when it should have applied to another. Benefit setup errors or late-arriving claims from other providers can also cause it.

What if the patient already paid?

Compare what they paid with the corrected PR amount. Refund any overpayment, or send an updated statement if they now owe more.

Does the payer's payment change too?

Usually. When patient responsibility goes down, the payer's portion typically goes up by the same amount, and the reverse.