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N924 Remark Code: MAO Determination Still Pending

N924 means the service is pending, not denied: when the encounter record was submitted, the Medicare Advantage Organization (MAO) had not yet made a payment responsibility determination. A later record should reflect the final decision.

Quick facts

Code
N924 (RARC N924)
Status
Active In use since July 1, 2026.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): Where a group code accompanies the pending status, it reflects an undetermined disposition rather than a patient or provider liability.
Official description
Pending (Not Denied) - The Medicare Advantage Organization (MAO) has not yet made a payment responsibility determination for the service at the time the encounter record was submitted.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N924 means

Of the four Medicare Advantage encounter status codes, N924 is the only one that describes an unfinished decision. The MAO had the service on record, but had not decided whether it was responsible for paying, at the moment the encounter record was created.

Think of it as a snapshot. It does not predict the outcome.

Where you might see it

  • In MAO encounter data sent to CMS.
  • In reports from delegated entities that adjudicate claims on a plan’s behalf.
  • Occasionally on a provider-facing response from a plan while a claim is still under review.

What to do

  1. Providers: check claim status through the plan’s portal or claim status inquiry. If records were requested, send them promptly so the review can finish.
  2. Do not bill the patient for a pending service beyond any cost sharing already collected at the visit.
  3. Plans and delegated entities: track pending encounters and make sure the final determination is reported once made, so encounter data matches the claim’s actual outcome.
  4. Follow up on age. Services that stay pending for a long time should be escalated rather than left open.

Codes that may appear with N924

  • OA-133 (The disposition of this service line is pending further review. (Use only with Group Code OA).): The disposition of the service line is pending further review.
  • N923 (Not Denied - The Medicare Advantage Organization (MAO) made a payment responsibility determination.): The MAO made its determination and did not deny the service.
  • N925 (Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for the service at the time the encounter record…): 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…): The MAO denied some but not all service lines.

N924 FAQ

Why would an encounter be submitted before a decision?

Encounter reporting runs on its own timelines. If a claim is still under review, for example awaiting records, the status at submission can be pending.

What happens next?

The MAO completes its review. The final status would then be expected to appear in updated encounter data or on the provider's remittance as determined, denied, or partially denied.

Should a provider resubmit?

No. A pending status is not a request for a new claim. Check claim status with the plan if a decision seems overdue.