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N766 Remark Code: Prior Payer Copay Not Covered

N766 means this payer does not cover a co-payment assessed by a previous payer. The secondary plan processed the claim but left the primary plan's copay unpaid, so it generally remains the patient's responsibility.

Quick facts

Code
N766 (RARC N766)
Status
Active In use since March 1, 2016.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The primary plan's copay stays with the patient unless another payer covers it or the patient is protected from cost-sharing.
Official description
This payer does not cover co-payment assessed by a previous payer.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N766 means

N766 is a coordination-of-benefits remark about copays. The primary plan applied a flat copayment and paid the rest; the secondary plan then looked at that copay and declined to cover it. The claim was processed correctly according to the secondary plan’s rules; N766 is simply explaining why the copay was left over.

It typically appears with CARC 275, and the copay is reported under group PR.

When it matters

  • The copay was already collected at the visit, so N766 needs no action beyond posting.
  • The copay was not collected, and the patient now owes it.
  • The patient may be protected from cost-sharing, for example as a Qualified Medicare Beneficiary or under certain Medicaid rules, in which case billing them may not be allowed.

What to do

  1. Check whether the copay was collected at the time of service.
  2. If it was not, confirm that no other coverage applies and that the patient is not protected from cost-sharing.
  3. Bill the patient for the copay if appropriate.
  4. If the secondary plan should have covered the copay under its terms, contact it with the primary’s explanation of benefits and ask for reprocessing.

How to prevent confusion

Record at registration whether each secondary plan covers primary copays. Front-desk staff can then collect the right amount up front and avoid small balances that are costly to chase later.

Codes that may appear with N766

  • 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.
  • PR-3 (Co-payment Amount): The co-payment amount, as reported by the primary payer.
  • N765 (This payer does not cover coinsurance assessed by a previous payer.): The same rule applied to coinsurance.
  • N408 (This payer does not cover deductibles assessed by a previous payer.): The same rule applied to a deductible.
  • N783 (Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary.): An alert for Qualified Medicare Beneficiaries, whose copayments generally cannot be collected from them.

N766 FAQ

Did I already collect this copay at the visit?

Often yes. If you collected the primary plan's copay at check-in, N766 simply confirms it stays with the patient. No further collection is needed.

Can a secondary plan refuse to cover a copay?

Yes. Coordination-of-benefits rules differ by plan, and some secondary plans do not cover primary cost-sharing at all or only for certain services.

What if the patient has Medicaid as secondary?

Medicaid rules on primary cost-sharing vary by state and by the patient's eligibility category, and some patients cannot be billed. Check the state's rules before billing the patient.