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N726 Remark Code: Conditional Payment Not Allowed

N726 means the payer will not make a conditional payment on this claim. Instead of paying temporarily while another insurer, such as liability, no-fault, or workers' compensation, decides, it expects the primary insurer to be billed and to respond first.

Quick facts

Code
N726 (RARC N726)
Status
Active In use since March 1, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The payer denies the line because it is not primary and will not pay conditionally. The provider should pursue the primary insurer, not the patient.
  • OA (Other Adjustment): Used by some payers to signal that another payer's decision is needed. It is not a patient balance.
Official description
A conditional payment is not allowed.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N726 means

Secondary payers, especially Medicare under its secondary payer rules, can sometimes pay a claim “conditionally” when a liability, no-fault, or workers’ compensation insurer is primary but has not paid promptly. The payment is provisional and may later be recovered.

N726 says the payer has decided not to do that for this claim. It usually means the payer believes the primary insurer is available and should be billed, often because that insurer has reported ongoing responsibility for the related care. Expect CARC 22 or CARC 19, 20, or 21 alongside it.

Common causes

  • A liability, no-fault, or workers’ compensation insurer has an open claim covering this condition.
  • The claim was sent to the secondary payer without first billing the primary insurer.
  • The claim did not show that the primary insurer was billed and failed to pay within the relevant timeframe.

What to do

  1. Identify the primary insurer from the paired CARC and the patient’s accident or injury history.
  2. Bill the primary insurer and follow its process through to a payment or denial.
  3. If the primary denies or does not pay, send that result to the payer that issued N726 and ask how it wants the claim resubmitted.
  4. If the service is unrelated to the injury, correct the diagnosis coding and request reprocessing.

How to prevent it

Capture accident and injury information at registration and route injury-related claims to the appropriate carrier first. Payer-order issues like this are covered in eligibility and COB denials.

Codes that may appear with N726

  • OA-22 (This care may be covered by another payer per coordination of benefits.): Another payer may be responsible under coordination of benefits.
  • OA-19 / CO-20 / CO-21 (Workers' compensation, liability, and no-fault carrier responsibility.): Identify which type of primary insurer the payer believes should pay.
  • M32 (Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer.): The opposite outcome: the payer made a conditional payment that may later need to be refunded.
  • N725 / N727 / N728 (Liability, no-fault, and workers' compensation insurer ORM reports.): An insurer has reported ongoing responsibility, a common reason a conditional payment is refused.
  • N479 (Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).): Asks for the other payer's explanation of benefits, often what unlocks processing.

N726 FAQ

What is a conditional payment?

It is a temporary payment a secondary payer, most often Medicare, may make when the primary insurer is not expected to pay promptly. The payer later seeks repayment if the primary pays.

Why would the payer refuse to pay conditionally?

Typically because it has information that the primary insurer is responsible and able to pay, for example an ongoing responsibility report, or because the claim lacks what the payer needs to justify a conditional payment.

What happens if the primary insurer denies?

Send the primary's denial or explanation of benefits to the payer that issued N726 and ask for the claim to be reconsidered.