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N926 Remark Code: MAO Partially Denied Service Lines

N926 means partially denied: the Medicare Advantage Organization (MAO) determined it had no payment responsibility for one or more service lines, but not all, at the time the encounter record was submitted. Some lines were accepted and others denied.

Quick facts

Code
N926 (RARC N926)
Status
Active In use since July 1, 2026.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Denied line amounts the provider must absorb or appeal, when the denial reason is a provider or billing issue.
  • PR (Patient Responsibility): Denied line amounts that may be the member's responsibility, where plan rules allow.
Official description
Partially Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for one or more service lines, but not all, 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 N926 means

A single claim often has several service lines. N926 is the Medicare Advantage encounter status for a mixed outcome: the MAO accepted payment responsibility for some lines and rejected it for others.

That makes N926 a claim-level summary. The real detail sits on each line.

Common reasons for partial denials

  • Bundling edits that fold one line into another. See NCCI bundling denials.
  • Units above the authorized amount or plan limits.
  • One service lacking medical necessity support while others are covered.
  • A non-covered item billed alongside covered services.

What to do

  1. Review each line and sort them into paid, correctable, and appealable.
  2. Correct billing errors such as missing modifiers in box 24D or wrong units in box 24G, and submit a corrected claim with frequency code 7 if the plan requires it.
  3. Appeal clinical or coverage denials for specific lines with supporting records.
  4. Bill the member only for lines assigned to PR, within plan rules.

How to prevent it

Scrub claims for bundling and unit problems before submission. Claims Validator flags common line-level errors before a claim goes out.

Codes that may appear with N926

  • CO-97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.): A line's benefit is included in another service, one common reason for a partial denial.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Some lines judged not medically necessary.
  • CO-198 (Precertification/notification/authorization/pre-treatment exceeded.): Authorization exceeded, so lines beyond the approved amount were denied.
  • N925 (Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for the service at the time the encounter record…): All service lines were denied, not just some.
  • N923 (Not Denied - The Medicare Advantage Organization (MAO) made a payment responsibility determination.): The MAO accepted responsibility with no denial.
  • N924 (Pending (Not Denied) - The Medicare Advantage Organization (MAO) has not yet made a payment responsibility determination for the service at the time…): The determination was still pending.

N926 FAQ

How do I know which lines were denied?

Look at the line-level adjustments. Accepted lines show payment or normal contractual adjustments; denied lines show denial reason codes.

Should I resubmit the whole claim?

Usually not. Work only the denied lines, either with a corrected claim that fixes them or an appeal, as the plan requires. Resubmitting paid lines can create duplicates.

Can partial denials be appealed?

Yes. Appeal the specific lines you disagree with, using the plan's appeal or dispute process.