Skip to main content

N804 Remark Code: Processed Through the OCE

N804 is an informational alert telling you the claim or service was processed through the Outpatient Code Editor (OCE), the software that edits institutional outpatient claims for coding validity and assigns payment attributes. Any action depends on the adjustment codes that come with it.

Quick facts

Code
N804 (RARC N804)
Status
Active In use since July 1, 2018.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): If a CO adjustment accompanies N804, an OCE edit led to a provider-liable reduction or denial on that line.
  • OA (Other Adjustment): An other adjustment alongside the alert usually reflects how the OCE packaged or grouped the line, not a patient balance.
Official description
Alert: The claim/service was processed through the Outpatient Code Editor (OCE).
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N804 means

The Outpatient Code Editor (OCE) is claim-editing software applied to institutional outpatient claims. It checks codes for validity and consistency, applies correct coding rules, and assigns attributes that drive payment, such as whether a line is packaged or paid separately. Medicare uses an integrated version for hospital outpatient claims, and other payers use comparable tools.

N804 simply tells you the claim went through that editor. On its own it asks nothing of you. Its value is context: if the same line carries a reduction or denial, the OCE’s logic is the likely source.

What to do

  1. Read the CARC on the same line. No adjustment beyond normal pricing means there’s nothing to fix.
  2. If there is a denial or packaging adjustment, check the codes, modifiers, units, and revenue codes on that line against your documentation.
  3. Correct coding errors by sending a corrected institutional claim through your usual process. If the edit was applied as intended, post the adjustment.
  4. For patterns, compare denied lines against the payer’s published editing rules. Our NCCI bundling guide explains many of the pairs that trigger outpatient edits.

Codes that may appear with N804

  • CO-97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.): The line was packaged into payment for another service, a common OCE outcome.
  • CO-236 (This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day…): A procedure or modifier combination conflicted with another service under correct coding rules.
  • N805 (Alert: The claim/service was processed through the Correct Code Editor (CCE).): The alert for claims processed through the Correct Code Editor instead.
  • CO-5 (The procedure code/type of bill is inconsistent with the place of service.): A procedure or bill type that doesn't fit the place of service, an edit outpatient claims often hit.

N804 FAQ

Is N804 a denial?

No. It is an alert. Look at the CARC on the same line. If the line paid in full, no action is needed.

Which claims go through the OCE?

Institutional outpatient claims, such as hospital outpatient bills. Medicare uses an integrated OCE for these claims, and other payers may use similar editors.

Where can I see the OCE edit that fired?

The remittance usually shows only the CARC and RARC. Your claim scrubber or the payer's claim status tools may show more detail about the specific edit.