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N781 Remark Code: QMB Patient, Deductible Alert

N781 is an alert that the patient is a Medicaid or Qualified Medicare Beneficiary (QMB). You should review your records for any deductible wrongly collected from the patient. The deductible may be billed to a subsequent payer, such as Medicaid, instead.

Quick facts

Code
N781 (RARC N781)
Status
Active In use since November 1, 2016; last modified March 1, 2018.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): The deductible cannot be collected from the patient but may be billed to a subsequent payer. Refund the patient if it was collected.
  • PR (Patient Responsibility): Even if the remittance labels the deductible as patient responsibility, QMB protections generally prevent collecting it from the patient.
Official description
Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N781 means

Qualified Medicare Beneficiaries are low-income Medicare enrollees whose state Medicaid program helps with Medicare costs. Providers may not bill them for Medicare cost-sharing. N781 flags that this patient has that status and asks you to check specifically for a deductible collected from them.

Deductibles are a common trap because they are often collected early in the year, before the QMB status shows on a remittance.

What to do

  1. Look at payments the patient made on this and nearby claims, particularly early-year visits.
  2. Refund any deductible collected from the patient.
  3. Bill the state Medicaid program, or the patient’s Medicaid plan, as the subsequent payer for the deductible.
  4. Flag the patient’s account as QMB so future deductibles are not collected at the front desk.

Codes that may appear with N781

  • PR-1 (Deductible Amount): The deductible amount N781 refers to.
  • OA-209 (Per regulatory or other agreement.): The provider cannot collect the amount from the patient but may bill a subsequent payer.
  • N782 (Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary.): The same QMB alert for coinsurance.
  • N783 (Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary.): The same QMB alert for copayments.
  • N192 (Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.): A general alert that the patient is a Medicaid or Qualified Medicare Beneficiary.

N781 FAQ

Can I bill a QMB patient for the Medicare deductible?

No. Federal law prohibits billing Qualified Medicare Beneficiaries for Medicare deductibles, coinsurance, and copayments.

Who pays the deductible instead?

The state Medicaid program may pay some or all of it, depending on state rules. Bill Medicaid as the subsequent payer, even if it pays less than the full amount.

What if we collected the deductible at check-in?

Refund it to the patient. That is what the alert asks you to check.