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N802 Remark Code: File With Rendering Doctor's Area Plan

N802 means the plan that received the claim does not pay it under its service area rules. The claim must be filed with the payer or plan that serves the area where the rendering physician is located.

Quick facts

Code
N802 (RARC N802)
Status
Active In use since March 1, 2018.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim was denied because it went to the wrong plan. The provider refiles with the correct plan; the patient is not billed for this reason.
Official description
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N802 means

Some payers are really networks of local plans or regional contractors, each responsible for claims from a defined geography. Which plan pays can depend on where the member lives, where the service happened, or where a particular provider is located. N802 tells you that for this claim, the deciding factor is the rendering physician’s location, and the plan that got your claim doesn’t cover that area.

The remark is normally paired with CARC 109 (not covered by this payer; send to the correct one). It is a routing problem, not a coverage decision about the service.

Common causes

  • Filed with the patient’s home plan when the payer’s rules require filing with the plan where the physician practices.
  • Multi-state practices. A group with clinicians in several states sends all claims to one plan.
  • Telehealth. The rendering clinician is in a different area from the patient, and the claim went to the plan serving the patient’s location.
  • Outdated payer ID in the practice management system after a plan changed its territories.

How to fix it

  1. Confirm the rendering physician’s service location as reported in box 32 and the provider’s enrollment.
  2. Identify the plan responsible for that area using the payer’s filing guidelines or provider services.
  3. Submit a new claim to that plan with its payer ID or mailing address.
  4. Watch timely filing. If you are near the limit, include proof of the original submission. See timely filing denials.

How to prevent it

  • Store a filing rule for each multi-plan payer that tells your system which plan to use based on provider location.
  • Review routing for telehealth and multi-state clinicians before the first claims go out.
  • Watch N557, N558, N559, and N802 together, since they all signal location-based misrouting.

Codes that may appear with N802

  • CO-109 (Claim/service not covered by this payer/contractor.): The claim isn't covered by this payer or contractor and must go to the correct one.
  • CO-B11 (The claim/service has been transferred to the proper payer/processor for processing.): The claim was forwarded to the proper payer rather than denied outright.
  • N559 (This claim/service is not payable under our service area.): Same service area rule, but based on where the ordering physician is located.
  • N557 (This claim/service is not payable under our service area.): Service area is decided by where the specimen was collected.
  • N558 (This claim/service is not payable under our service area.): Service area is decided by where the equipment was received.

N802 FAQ

Why does the rendering physician's location matter?

Some payers operate as a group of regional plans or contractors, each responsible for a defined area. For certain claims they assign responsibility based on where the physician who performed the service is located, not where the patient lives.

Do I need a new claim for the other plan?

Usually yes. Submit a new claim to the correct plan's payer ID or address. If the original plan forwarded the claim for you, the remittance will typically say so, often with CARC B11.

What about timely filing?

The correct plan applies its own filing limit. Keep the N802 remittance as proof you filed on time with the wrong plan, since some payers consider that in a timely filing appeal.