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N791 Remark Code: History and Physical Report Missing

N791 means the claim could not be paid because the history and physical (H&P) report the payer requires for this service was not received. The fix is to send the H&P through the payer's attachment or records process.

Quick facts

Code
N791 (RARC N791)
Status
Active In use since July 1, 2017.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The service is held or denied for missing documentation. The provider is expected to supply the report rather than bill the patient.
Official description
Missing history & physical report.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N791 means

A history and physical (H&P) documents the patient’s clinical picture before a significant service: the presenting problem, past medical history, medications, exam findings, and the plan. Payers ask for it when they need to see that a procedure, admission, or high-cost service was justified by the patient’s condition at the time.

N791 tells you the payer expected that report and has nothing on file. It is a documentation gap, not a coding error, and it usually sits next to CARC 252 (attachment required) or CARC 16 (information missing). If the payer sent a records request earlier and got no answer, CARC 226 may appear instead.

Common causes

  • Attachment never sent. The claim went out electronically, but the H&P that the payer’s policy requires was not submitted through its attachment process.
  • Records request missed. The payer asked for records, and the request went to an old address or sat unanswered past the deadline.
  • Attachment not linked. The H&P was faxed or uploaded without the claim number or attachment control number, so the payer couldn’t match it.
  • Wrong document sent. An operative note or discharge summary was sent in place of the H&P.

How to fix it

  1. Find the H&P for the date of service in the chart and confirm it is signed and dated.
  2. Check how the payer wants it: portal upload, fax cover sheet, or electronic attachment with a control number referenced on the claim.
  3. Send it with the claim number and patient identifiers on every page.
  4. Call the payer to confirm receipt and ask whether it will reprocess the claim or whether you must request reconsideration.
  5. If the claim was finalized as denied, follow the payer’s appeal or reopening process and include the H&P.

How to prevent it

  • Know which services each major payer reviews with an H&P, and attach it on the first submission.
  • Route payer records requests to a single monitored queue with due dates.
  • Use attachment control numbers consistently so documents match the claim they support.
  • See how CARC and RARC codes work together for reading documentation denials.

Codes that may appear with N791

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment or other documentation is required; N791 identifies it as the H&P.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information needed for adjudication, and N791 tells you which document.
  • CO-226 (Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.): The payer requested information from the provider and did not receive it in time.
  • N792 (Incomplete/invalid history & physical report.): The H&P was received but was incomplete or invalid, rather than missing entirely.
  • N221 (Missing Admitting History and Physical report.): Specifically the admitting history and physical for an inpatient stay.
  • M127 (Missing patient medical record for this service.): The broader patient medical record for the service is missing, not just the H&P.

N791 FAQ

What counts as a history and physical report?

It is the clinician's documented patient history, review of systems, examination findings, and assessment, usually recorded before a procedure or admission. The payer wants the version that supports the service billed.

Should I send a corrected claim for N791?

Usually not. The claim data may be fine; what's missing is the document. Send the H&P through the payer's attachment channel, referencing the claim number, unless the payer tells you to resubmit.

What if the H&P doesn't exist?

If the required report was never documented, don't create one after the fact to support billing. Talk to your compliance lead about the claim.