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N916 Remark Code: Third Party Pays, Then Reimburses

N916 means a third party will render payment to the provider, and that third party will then reimburse you for covered services. Payment for the claim flows through another entity instead of directly from the payer on this remittance.

Quick facts

Code
N916 (RARC N916)
Status
Active In use since July 1, 2025.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): Amounts not paid on this remittance because payment is routed through a third party. Not a patient balance.
  • CO (Contractual Obligation): Some payers report the routed amount as a contractual adjustment. Confirm the arrangement before writing anything off.
Official description
The third party will render payment to the provider, and they will reimburse you for covered services.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N916 means

The wording of N916 is unusual. It says a third party pays “the provider” and “they will reimburse you.” In practice, payers use it when an arrangement moves the money through another organization, for example a delegated entity or vendor that receives payment and passes it along.

The takeaway for billing is simple: the payer on this remittance is not paying you directly for this claim, and a separate payment should come from somewhere else.

Common situations

  • The service is covered through a delegated medical group or management organization.
  • A facility receives payment for services by outside providers and pays them.
  • A vendor or program administrator handles payment for a carved-out benefit.

What to do

  1. Ask the payer who the third party is and how payment will reach you.
  2. Contact that entity to confirm it has what it needs to reimburse you, including any contract or billing requirements.
  3. Keep the claim open in accounts receivable, noting the expected payer.
  4. Follow up if payment does not arrive within the arrangement’s normal timeframe.

How to prevent confusion

Record delegated and carved-out arrangements by payer and plan in your eligibility workflow so staff know in advance where payment will come from.

Codes that may appear with N916

  • OA-24 (Charges are covered under a capitation agreement/managed care plan.): Charges covered under a capitation agreement or managed care plan, one situation where another entity handles payment.
  • CO-100 (Payment made to patient/insured/responsible party.): Payment made to the patient or insured, a different routing outcome.
  • N803 (Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital.): The contracted medical group or hospital is responsible for submitting the claim.
  • N538 (A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.): A facility is responsible for paying outside providers who serve its patients.
  • N904 (The transportation vendor is responsible for this claim.): A transportation vendor is responsible for the claim.

N916 FAQ

Who is the third party?

The remark does not name it. It could be a delegated medical group, a facility, a vendor, or another entity that holds financial responsibility. Ask the payer if the remittance does not identify it.

Do I need to rebill?

Not usually to this payer. Confirm with the payer and the third party whether any separate billing is needed to receive payment.

Can I bill the patient while waiting?

No. The remark says covered services will be reimbursed through the third party, so the amount is not patient responsibility.