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N803 Remark Code: Bill the Contracted Group or Hospital

N803 means the payer is not responsible for paying this claim directly. Under the patient's managed care arrangement, submitting and paying claims for this service is the responsibility of a contracted medical group or hospital, so the claim should be billed there.

Quick facts

Code
N803 (RARC N803)
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 entity. It is not a patient balance; bill the delegated group or hospital.
  • OA (Other Adjustment): Some payers report the amount as an other adjustment because the claim belongs to a capitated or delegated arrangement.
Official description
Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N803 means

In many managed care arrangements, the health plan hands financial risk for some or all services to a contracted medical group, IPA, or hospital. That entity, not the plan, receives claims and pays providers for the delegated services. N803 is how the plan tells you your claim belongs to that entity.

It often appears with CARC 24 (covered under a capitation or managed care agreement) or CARC 109 (send to the correct payer). The service may well be covered; you just sent it to the wrong place.

Common causes

  • Eligibility checked only at the plan level. The response showed active coverage, but no one noted that the member is assigned to a delegated group.
  • Division of financial responsibility misread. Some services go to the plan and others to the group or hospital, depending on the contract.
  • Out-of-area or emergency care, where providers bill the plan by habit but the member’s group holds responsibility.
  • Member reassigned to a new group mid-year.

How to fix it

  1. Identify the responsible entity from the member card, the eligibility response, or by calling the plan.
  2. Get its claims address or payer ID and any submission rules, which can differ from the plan’s.
  3. Submit the claim to the medical group or hospital as a new claim.
  4. Keep the N803 remittance as proof you filed timely with the plan, in case the group’s filing limit becomes an issue. See timely filing denials.

How to prevent it

  • Capture the patient’s assigned medical group at registration and store it on the insurance record.
  • Build a payer rule that routes delegated services to the group automatically.
  • Recheck group assignment at each visit. See eligibility and COB denials for verification habits that catch it early.

Codes that may appear with N803

  • OA-24 (Charges are covered under a capitation agreement/managed care plan.): Charges are covered under a capitation agreement or managed care plan.
  • CO-109 (Claim/service not covered by this payer/contractor.): The claim isn't covered by this payer and must go to the correct entity.
  • N802 (This claim/service is not payable under our service area.): Wrong plan because of the rendering physician's service area, not delegation.
  • CO-256 (Service not payable per managed care contract.): The service is not payable under the managed care contract.

N803 FAQ

Who is the contracted medical group?

It's the medical group, independent practice association, or hospital that the health plan pays to manage care for the patient. The member card or eligibility response often names it.

Can I bill the patient if the medical group denies too?

Not automatically. Whether the patient is liable depends on your contract and the reason the group denied. An N803 denial itself doesn't make the patient responsible.

Does the timely filing clock restart?

No. The medical group applies its own filing limit, which may be short. Send the claim there as soon as you receive N803.