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N758 Remark Code: Adjusted per Prior Authorization

N758 means the payer adjusted this claim based on its prior authorization decision. What was billed did not match what the authorization approved, for example more units, more days, or a different service, so the payer paid only what was authorized.

Quick facts

Code
N758 (RARC N758)
Status
Active In use since July 1, 2015.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The unauthorized portion is the provider's responsibility under most contracts. It is not billable to the patient.
  • PR (Patient Responsibility): Some plans assign unauthorized care to the member, particularly when the member was informed. Confirm plan and contract terms before billing.
Official description
Adjusted based on the prior authorization decision.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N758 means

A prior authorization decision defines what the payer agreed to cover: the service, number of units or visits, date span, provider, and sometimes the setting. N758 means the payer compared your claim with that decision and adjusted the difference. It is a reconciliation between what was approved and what was billed.

The remark often comes with CARC 198 (authorization exceeded), CARC 39 (denied at authorization), or CARC 284 (authorization does not apply to the service billed).

Common causes

  • More visits, days, or units were billed than the authorization allowed.
  • Services were provided after the authorization expired.
  • The billed service or its modifiers differ from the approved service.
  • A request to extend or modify the authorization was pending or denied when care continued.
  • The rendering provider or location differs from the one on the authorization.

How to fix it

  1. Pull the authorization and compare it line by line with the claim.
  2. If the claim was wrong, for example the wrong units or dates, submit a corrected claim with resubmission code 7.
  3. If you had an extension or updated approval, send it and request reprocessing.
  4. If the authorization was reduced or denied and you disagree, file a utilization management appeal with clinical support.
  5. Post the valid unauthorized amount according to the group code.

How to prevent it

Track authorized units and end dates against services scheduled, and request extensions before they run out. The authorization and referral guide outlines how to build those checks.

Codes that may appear with N758

  • CO-198 (Precertification/notification/authorization/pre-treatment exceeded.): The authorization was exceeded, a common reason for N758.
  • CO-39 (Services denied at the time authorization/pre-certification was requested.): Services were denied when authorization was requested.
  • CO-284 (Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services.): The authorization number may be valid but does not apply to the billed services.
  • N54 (Claim information is inconsistent with pre-certified/authorized services.): The claim information is inconsistent with the pre-certified or authorized services.
  • N45 (Payment based on authorized amount.): Payment is based on the authorized amount.
  • N719 (Penalty applied based on plan requirements not being met.): A penalty applied for not meeting a plan requirement, such as late precertification.

N758 FAQ

Is N758 a full denial?

Not necessarily. It often means partial payment: the authorized portion was paid and the rest adjusted. Look at the paired CARC and the adjustment amount.

What if we got an authorization update the payer didn't apply?

Send the updated authorization with the reference number and dates and ask the payer to reprocess.

Can I appeal the authorization decision itself?

Usually yes, through the payer's utilization management appeal process, which may be separate from claim appeals. Deadlines vary.