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N854 Remark Code: Exhaust Primary OHI Appeals First

N854 is an alert that if the patient's primary other health insurance (OHI) denied the services, every appeal level with that primary plan must be exhausted before this payer will consider the claim. A primary denial alone isn't enough to shift payment to the secondary payer.

Quick facts

Code
N854 (RARC N854)
Status
Active In use since July 1, 2021.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): The claim is held pending the primary plan's final decision. It isn't a patient balance yet.
  • CO (Contractual Obligation): If denied under CO, the provider must first finish primary appeals before the secondary payer will reconsider.
Official description
Alert: If you have primary other health insurance (OHI) coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbursement.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N854 means

When a patient has other health insurance that is primary, a secondary payer normally pays after the primary. If the primary denies, some secondary payers won’t step in until the provider has fully contested that denial. N854 is the alert stating that rule: exhaust all appeal levels with the primary OHI first, then come back.

The term “other health insurance” is used notably by TRICARE, which is generally secondary to other coverage, but other payers may send N854 too.

What to do

  1. Review the primary denial and decide whether an appeal has merit.
  2. Work through each level of the primary plan’s internal appeal process, keeping every decision letter.
  3. After the final decision, submit to the secondary payer with the primary’s final EOB and appeal decisions.
  4. Track filing deadlines for both payers throughout. See eligibility and COB denials for coordination of benefits basics.

Codes that may appear with N854

  • OA-22 (This care may be covered by another payer per coordination of benefits.): The care may be covered by another payer under coordination of benefits.
  • CO-276 (Services denied by the prior payer(s) are not covered by this payer.): Services denied by the prior payer are not covered by this payer.
  • N4 (Missing/Incomplete/Invalid prior Insurance Carrier(s)): The prior payer's EOB is missing or invalid.
  • OA-136 (Failure to follow prior payer's coverage rules. (Use only with Group Code OA)): Failure to follow the prior payer's coverage rules.

N854 FAQ

What does OHI mean?

Other health insurance is coverage the patient has besides this payer that pays first. The term is used by TRICARE among other payers.

What proof do I need that appeals were exhausted?

Usually the primary plan's final appeal decision letter or EOB showing that no further internal appeal is available. Ask the secondary payer what it accepts.

Does timely filing still apply?

Yes. Secondary payers have their own filing rules, sometimes measured from the primary's final decision. Keep dated copies of every appeal.