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N925 Remark Code: MAO Found No Payment Responsibility

N925 means denied: the Medicare Advantage Organization (MAO) determined it had no payment responsibility for the service at the time the encounter record was submitted. The reason for the denial is carried by the adjustment reason code and other remarks.

Quick facts

Code
N925 (RARC N925)
Status
Active In use since July 1, 2026.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): A denied amount the provider absorbs, for example for authorization or billing issues, unless an appeal succeeds.
  • PR (Patient Responsibility): A denied amount the member may owe, for example when the service is excluded from the plan and the member was properly informed.
Official description
Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility 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 N925 means

N925 is the denied member of the Medicare Advantage encounter status set. It records that the MAO decided the service was not its financial responsibility at the time the encounter record was created. The entire service is affected, unlike N926, which covers only some lines.

N925 describes the outcome, not the cause. Always read it alongside the CARC and any other remarks.

Where you might see it

  • In encounter data that MAOs and delegated entities report.
  • On a remittance or response from a plan or delegated entity for a denied service.

What to do

  1. Find the reason in the CARC and other remarks on the line.
  2. Fix correctable errors such as a wrong member ID, missing authorization number in box 23, or wrong payer, and resubmit as the plan directs.
  3. Appeal if you disagree with a coverage or medical necessity decision, following your contract or the non-contracted provider appeal process.
  4. Check member liability rules before sending a patient statement.

How to prevent it

Verify Medicare Advantage enrollment and authorization requirements before scheduled services. See authorization and referral denials.

Codes that may appear with N925

  • CO-197 (Precertification/authorization/notification/pre-treatment absent.): Authorization absent, one common reason an MAO denies responsibility.
  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service is not covered under the member's benefit plan.
  • CO-109 (Claim/service not covered by this payer/contractor.): The claim belongs to a different payer or contractor.
  • N926 (Partially Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for one or more service lines, but not…): Only some service lines were denied.
  • N923 (Not Denied - The Medicare Advantage Organization (MAO) made a payment responsibility determination.): The MAO accepted payment responsibility.
  • N887 (Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the…): Appeal rights for providers not contracted with the Medicare Advantage plan.

N925 FAQ

What does no payment responsibility mean?

The plan concluded it does not owe payment for the service. Reasons can include non-coverage, missing authorization, the member not being enrolled, or another payer being responsible.

Can a provider appeal?

Yes, generally. Contracted providers follow their agreement's dispute process. Non-contracted providers follow the Medicare Advantage appeal process, which requires a waiver of liability.

Can the member be billed?

Only if the group code and plan rules allow it. Medicare Advantage rules protect members from being billed in many denial situations, especially for contracted providers.