RARC N14: Payment Based on Contractual Amount or Fee Schedule

What Does RARC N14 Mean?

When N14 was active, it told the billing specialist that the amount the payer paid (or didn't pay) on a line was governed by a pre-established rate — a negotiated contract rate with the provider, a government or payer fee schedule, or another type of maximum allowable amount — rather than being an assessment of medical necessity, coding accuracy, or eligibility. In other words, the claim itself wasn't being rejected; the payer was explaining that the difference between the billed charge and the paid amount reflected the applicable rate ceiling, not a coverage problem.

N14 was retired from the RARC code set effective October 1, 2007. CMS and the other X12 maintainers deactivated it as part of an ongoing effort to consolidate overlapping remark codes, and its function was absorbed into CARC 45 ('Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement'), which by itself now conveys the same contractual-amount concept that N14 used to supplement. Because of this, N14 should not appear on remittance advices for dates of service processed under current code sets.

A biller encountering N14 today is most likely looking at an older remittance, a legacy report, archived data, or a payer system that has not fully updated its code tables. It should not be interpreted using more recent or unrelated meanings; its documented function was always tied to contractual/fee-schedule payment amounts, not to claim resubmission or missing information.

What to Do

If N14 appears on a historical remittance, treat it the same way you would treat CARC 45 today: verify the payment against the applicable fee schedule or the provider's contracted rate for that payer and date of service, and confirm the adjustment amount matches the contracted or fee-schedule ceiling rather than an underpayment. No resubmission is implied by the code itself.

If N14 appears on a claim processed recently, flag it as unexpected — contact the payer, since a currently deactivated code showing up on a new remittance may indicate the payer's system is using an outdated code table, which is worth reporting through your normal payer-issue escalation process rather than assuming it reflects a live coverage decision.

Common Scenarios

• A biller reviewing an archived remittance advice from before 2007 finds N14 attached to a line where the paid amount is lower than the billed charge, reflecting the provider's contracted fee schedule rate for that payer.
• A practice migrating historical accounts-receivable data encounters N14 in legacy files and needs to map it to the modern equivalent, CARC 45, for reporting consistency.
• A clearinghouse or payer system that hasn't fully retired legacy code tables occasionally still transmits N14 on a current remittance, which the biller flags to the payer as an outdated code reference rather than acting on it as a new denial reason.
• During a payer contract audit, a biller cross-references old N14-coded adjustments against the fee schedule in effect at the time to confirm historical payments were calculated correctly.

Commonly Paired With

RARC N14 commonly appears alongside these CARC denial codes: