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N826 Remark Code: Patient Not Eligible for MSSP Rule

N826 means the patient did not meet the inclusion criteria for the Medicare Shared Savings Program (MSSP). The claim relied on an MSSP-related rule, such as a payment waiver available to accountable care organizations (ACOs), that applies only to patients who qualify.

Quick facts

Code
N826 (RARC N826)
Status
Active In use since November 1, 2019.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The service wasn't paid under the MSSP rule. Under CO the amount is a provider liability.
Official description
Patient did not meet the inclusion criteria for the Medicare Shared Savings Program.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N826 means

The Medicare Shared Savings Program lets accountable care organizations take on shared accountability for a group of Medicare beneficiaries. To support that, CMS allows certain ACOs to use payment rule waivers, such as the skilled nursing facility three-day rule waiver, for qualifying beneficiaries. Those waivers apply only when the patient and provider meet the program’s criteria.

N826 appears when a claim depended on an MSSP rule and the patient didn’t meet the inclusion criteria. Medicare then processes the claim as if the waiver didn’t exist, which often leads to a denial under the standard rule.

Common causes

  • Patient not assigned to the ACO for the relevant period, or assignment changed.
  • Waiver-specific criteria not met, such as clinical conditions or care settings required by the waiver.
  • Provider or facility not an approved participant for that waiver on the date of service.
  • Beneficiary coverage issues, such as Medicare Advantage enrollment, that take the patient outside MSSP.

How to fix it

  1. Confirm assignment through your ACO’s beneficiary lists for the relevant period.
  2. Check the waiver’s criteria in the ACO’s participation agreement and CMS guidance, and compare them with the patient’s record.
  3. Verify participant status of the billing provider or facility on the date of service.
  4. If the patient qualified, contact the Medicare Administrative Contractor or ACO to have the claim reprocessed, or appeal with evidence.
  5. If not, review whether the service can be paid under standard Medicare rules.

How to prevent it

  • Check ACO assignment and waiver eligibility before relying on a waiver, not after billing.
  • Coordinate with the ACO’s care management team, which usually tracks eligible beneficiaries.
  • Document waiver eligibility in the chart at the time of the decision.

Codes that may appear with N826

  • CO-272 (Coverage/program guidelines were not met.): Coverage or program guidelines were not met.
  • CO-A6 (Prior hospitalization or 30 day transfer requirement not met.): The prior hospitalization requirement wasn't met, relevant when an ACO skilled nursing waiver was relied on.
  • CO-96 (Non-covered charge(s).): A general non-covered charge denial.
  • CO-132 (Prearranged demonstration project adjustment.): An adjustment for a prearranged demonstration project, a different Medicare initiative.

N826 FAQ

What is the Medicare Shared Savings Program?

It's a Medicare program in which accountable care organizations take responsibility for the quality and cost of care for an assigned population of beneficiaries. Certain payment waivers are available to participating ACOs for qualifying patients.

Why wasn't my patient eligible?

Common reasons include the patient not being assigned or aligned to the ACO, the patient failing a waiver's specific criteria, or the provider not being an ACO participant on the date of service.

What happens to the claim?

It is processed under regular Medicare rules without the waiver. If those rules weren't met, the service may be denied. Talk to your ACO before billing the patient.