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N7 Remark Code: Processed Under Major Medical

N7 is an informational alert. It tells you the payer's processing of the claim or service included consideration under the plan's major medical provisions, which can change the deductible, coinsurance, and payment compared with the base benefit.

Quick facts

Code
N7 (RARC N7)
Status
Active In use since January 1, 2000; last modified July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Deductible or coinsurance applied under the major medical benefit is the patient's share, as reported on the remittance.
  • CO (Contractual Obligation): Any contractual reduction on the same line is the provider's write-off. N7 only describes which benefit tier was used.
Official description
Alert: Processing of this claim/service has included consideration under Major Medical provisions.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N7 means

Older and some specialty benefit designs split coverage into a base (basic) benefit and a major medical benefit. When a claim is processed wholly or partly under the major medical portion, the payer may attach N7 so you understand why the cost-sharing looks different from a typical claim for that patient.

N7 does not explain a denial. It is context for the amounts on the line, and it most often appears with CARC 102 (major medical adjustment) or with deductible and coinsurance codes.

What to do

  1. Post the remittance as reported. Apply the payer payment and move PR amounts to the patient.
  2. Check the patient statement. Make sure the patient’s balance reflects the major medical deductible or coinsurance shown on the ERA, not an estimate from a different benefit tier.
  3. Question only real discrepancies. If the base benefit should have paid more before major medical applied, call the payer with the plan details.

Because N7 is informational, there is nothing to correct or resubmit. For help reading remark codes alongside their reason codes, see our CARC and RARC guide.

Codes that may appear with N7

  • CO-102 (Major Medical Adjustment.): A major medical adjustment, which N7 accompanies to explain that the major medical benefit was applied.
  • PR-1 (Deductible Amount): Major medical coverage often has its own deductible, which may show up as patient responsibility.
  • PR-2 (Coinsurance Amount): Coinsurance calculated under the major medical benefit.
  • N16 (Family/member Out-of-Pocket maximum has been met.): Out-of-pocket maximum was met and payment moved to a higher percentage.
  • N23 (Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.): Alerts that patient liability may be affected by coordination of benefits or maximum benefit rules.
  • N212 (Charges processed under a Point of Service benefit.): Charges processed under a point-of-service benefit rather than major medical.

N7 FAQ

Do I need to do anything when I see N7?

Usually no. Post the payment and patient responsibility as reported. Act only if the paired CARC signals a denial or the amounts look wrong.

What are major medical provisions?

Some plans pair a basic benefit with a broader major medical benefit that applies after the basic benefit is used or for services it does not cover. Each tier can have different deductibles and coinsurance.

Why is the patient's share higher with N7?

Major medical coverage often carries its own deductible or coinsurance. Check the member's plan documents or eligibility response for the specific terms.