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N923 Remark Code: MAO Payment Determination Made

N923 means the service was not denied: the Medicare Advantage Organization (MAO) made a payment responsibility determination for it. It is a status marker tied to encounter reporting rather than an instruction to the provider.

Quick facts

Code
N923 (RARC N923)
Status
Active In use since July 1, 2026.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any contractual adjustments on the service. N923 itself signals only that the MAO accepted payment responsibility.
Official description
Not Denied - The Medicare Advantage Organization (MAO) made a payment responsibility determination.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N923 means

Medicare Advantage organizations report the services their members receive to CMS as encounter records. Four remark codes let those records show whether the plan was responsible for paying for each service. They describe the possibilities: determined, pending, denied, and partially denied.

N923 is the “determined, not denied” status. It confirms the MAO made its payment decision and accepted responsibility for the service. It is the routine, expected outcome for a covered service.

Where you might see it

  • MAOs and their vendors use the code when preparing encounter data.
  • Delegated entities, such as medical groups or IPAs that pay claims for a plan, may use it in their own encounter reporting to the plan.
  • Providers may occasionally see it on a remittance or encounter response from a plan or delegated entity.

What to do

  1. Post the payment as shown by the remittance amounts.
  2. Use the reason codes, not N923, to understand any reductions.
  3. Delegated entities should make sure their encounter submissions carry the correct determination status for each service, since the status must match how the claim was actually handled.

Codes that may appear with N923

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The usual contractual adjustment on a service the plan has taken payment responsibility for.
  • N924 (Pending (Not Denied) - The Medicare Advantage Organization (MAO) has not yet made a payment responsibility determination for the service at the time…): Pending: the MAO had not yet made a determination when the encounter was submitted.
  • N925 (Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for the service at the time the encounter record…): Denied: the MAO determined it had no payment responsibility.
  • N926 (Partially Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for one or more service lines, but not…): Partially denied: some service lines were not the MAO's responsibility.

N923 FAQ

Who uses N923?

It is part of a set of codes describing a Medicare Advantage organization's payment determination status on encounter records. Providers may see it only if a plan or its delegated entity passes that status along.

Does N923 mean the claim was paid in full?

Not necessarily. It means the plan took payment responsibility. The actual payment and any cost sharing are shown by the amounts and adjustment codes on the remittance.

Do I need to do anything?

No action is needed because of N923. Post the payment and adjustments as usual.