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N915 Remark Code: Predetermination Not Allowed

N915 means the member's plan does not allow predetermination of services. The payer will not review the proposed treatment in advance or estimate benefits for it; coverage will be decided when an actual claim is submitted.

Quick facts

Code
N915 (RARC N915)
Status
Active In use since July 1, 2025.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): On a predetermination response, reflects that no estimate was made. Nothing is owed by or billed to the patient because of N915 itself.
Official description
Predetermination of services is not allowed under the member's plan.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N915 means

Many dental plans and some medical plans let providers send a predetermination, also called a pre-treatment estimate, before costly services. The plan reviews the proposed treatment and states what it expects to pay.

Not every plan offers that. N915 is the response when the member’s plan does not. The request itself was not wrong, and it does not mean the service is denied; the plan simply does not make advance determinations.

Common causes

  • The plan design, such as some self-funded or government programs, excludes predeterminations.
  • The service type is not eligible for predetermination under the plan.
  • The request went to a plan that handles advance review only through prior authorization.

What to do

  1. Check whether prior authorization is required for the service. That is a separate process, and missing it can cause a denial later. See authorization and referral denials.
  2. Verify benefits through the eligibility response or the plan’s provider services line.
  3. Give the patient a written estimate based on what you learn, noting its limitations.
  4. Proceed with treatment and bill the claim normally.

How to prevent it

Note which plans do not accept predeterminations in your payer reference file so staff skip the step and go straight to benefits verification.

Codes that may appear with N915

  • CO-101 (Predetermination: anticipated payment upon completion of services or claim adjudication.): Predetermination: anticipated payment upon completion of services, the response you would expect if predetermination were allowed.
  • CO-A1 (Claim/Service denied.): A general denial of the predetermination request, with N915 as the reason.
  • N133 (Alert: Services for predetermination and services requesting payment are being processed separately.): Predetermination and payment requests are being processed separately.
  • N183 (Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan…): A predetermination advisory that more documentation will be needed when the service is billed.
  • N360 (Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination.): The predetermination estimate did not account for coordination of benefits.

N915 FAQ

Is predetermination the same as prior authorization?

No. Prior authorization is a required approval for certain services. Predetermination is usually an optional advance review of benefits. N915 does not say whether authorization is needed, so check that separately.

Can I still perform the service?

Yes. N915 only means the plan will not give an advance estimate. Coverage will be determined from the claim.

How do I estimate the patient's cost without it?

Use the eligibility and benefits response and the plan's published coverage policies to prepare an estimate, and explain to the patient that it is not a guarantee.