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N765 Remark Code: Prior Payer Coinsurance Not Covered

N765 means this payer does not cover coinsurance assessed by a previous payer. When it processes the claim as secondary or tertiary, it will not pay the coinsurance left by the primary payer, so that amount stays with the patient or another payer.

Quick facts

Code
N765 (RARC N765)
Status
Active In use since March 1, 2016; last modified March 1, 2018.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The prior payer's coinsurance remains the patient's responsibility, unless another payer or a regulatory rule covers it.
Official description
This payer does not cover coinsurance assessed by a previous payer.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N765 means

When a patient has more than one plan, the secondary plan often covers some or all of what the primary left as patient responsibility. N765 tells you this secondary plan does not do that for coinsurance. It processed the claim, looked at the coinsurance the primary assigned, and declined to pay it.

The remark usually pairs with CARC 275 under group PR. It is a benefit design outcome, not an error on the claim.

When to double-check

  • The secondary is a plan you expected to cover cost-sharing, such as a Medicaid plan or a supplemental policy.
  • The patient’s eligibility or dual status may make them protected from cost-sharing.
  • The primary payer’s explanation of benefits was attached incorrectly or showed the wrong amounts.

What to do

  1. Confirm the coordination-of-benefits details: the primary payer’s payment and patient responsibility, and the secondary’s processing.
  2. Check whether the patient has any other coverage that could pay the coinsurance.
  3. Check whether the patient is protected from cost-sharing, for example as a Qualified Medicare Beneficiary. If so, do not bill them.
  4. If none applies, bill the patient for the coinsurance.
  5. If the secondary processed incorrectly, contact it with the primary payer’s explanation of benefits.

How to prevent surprises

Verify both plans at intake and note whether the secondary covers primary cost-sharing, so estimates and patient conversations are accurate. The eligibility and COB guide explains how to set that up.

Codes that may appear with N765

  • PR-275 (Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group Code PR)): The prior payer's patient responsibility is not covered by this payer.
  • OA-23 (The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)): Shows the impact of the prior payer's adjudication on this claim.
  • N766 (This payer does not cover co-payment assessed by a previous payer.): The same rule for a copayment assessed by the prior payer.
  • N408 (This payer does not cover deductibles assessed by a previous payer.): The same rule for a deductible assessed by the prior payer.
  • N782 (Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary.): An alert for patients who are Qualified Medicare Beneficiaries, whose coinsurance generally cannot be collected from them.

N765 FAQ

Why won't the secondary payer cover the coinsurance?

Some secondary plans are designed to pay only for services or amounts they would cover on their own, not to fill in another plan's cost-sharing. The plan's coordination of benefits terms determine this.

Can I bill the patient for the coinsurance?

Usually yes when N765 comes with a PR group code, unless the patient has another payer or protections apply, such as Qualified Medicare Beneficiary status.

Should I bill a third payer?

If the patient has additional coverage, send the claim with both prior explanations of benefits. That payer may cover the remaining coinsurance.