In U.S. medical billing and coding for 2025, understanding the n104 remark code is vital for clearing Medicare denials. This code signals jurisdiction issues that block claim payment. In this article, you’ll discover what triggers N104, how recent 2025 updates may impact processing, and how to fix and prevent it.
What Is the N104 Remark Code?
The n104 remark code shows up on Medicare remittance advice when a claim is not payable because it was submitted to the wrong contractor jurisdiction. Essentially, Medicare will not process payment if the service region doesn’t match the contractor responsible in that geographic area.:contentReference[oaicite:0]{index=0}
2025 Updates & Why It Matters
In 2025, Medicare contractor jurisdictions remain structured regionally, and dozens of thousands of denials still cite code N104. For example, denial processes with reason code 109 often pair with N104.:contentReference[oaicite:1]{index=1}
Additionally, CMS continues to publish quarterly updates to CARC/RARC tables, so staying current helps ensure your systems map codes properly. Although the structure hasn’t changed in 2025, some MAC regions have been realigned—so verifying the current contractor directory on CMS.gov remains crucial.
Common Causes of N104 in 2025
- Submitting to the wrong Medicare Administrative Contractor (MAC) for beneficiary region.
- Using an outdated contractor table in billing software.
- Misidentifying state or ZIP-based jurisdiction boundaries.
How to Resolve an N104 Claim Denial
- Confirm the beneficiary’s permanent ZIP code via the SSA or Medicare database.
- Check the current MAC assignment directory on CMS.gov to find the correct contractor.:contentReference[oaicite:2]{index=2}
- Resubmit the claim to the correct jurisdiction contractor.
- Update your billing system’s jurisdiction tables quarterly, matching CMS’s CARC/RARC updates.
Impact on Revenue Cycle & Prevention Tips
Denied claims with n104 remark code delay reimbursement and waste processing resources. In 2025, incorporating jurisdiction validation into your scrubbing process helps avoid these denials.
- Automate validation by ZIP code prior to claim submission.
- Align software vendor updates with MAC realignments as CMS posts them.
- Train revenue cycle staff to spot common mis-routing issues and how to reroute correctly.
Internal & External Resources
For internal reference, review your common denial reasons article—particularly sections on denial due to incorrect contractor routing. For coding policy alignment, link to detailed ICD‑10 coding tips or prior authorization guidance.
Explore authoritative external sources like:
- CMS 2025 official guidelines on contractor directories and RARC/CARC.
- AHIMA guidance on remittance advice codes and claims processing.
FAQ
What is the difference between CARC 109 and RARC N104?
CARC 109 indicates “claim/service not covered by this payer/contractor.” N104 provides the specific remark that the claim falls outside the payer’s jurisdiction. Together, they explain why the denial occurred.:contentReference[oaicite:3]{index=3}
Can N104 occur for non‑Medicare claims?
No. The n104 remark code is specific to Medicare remittance advice for jurisdiction denials. Commercial payers may use different code systems.
How often does Medicare update jurisdiction data?
Medicare contractor map updates occur quarterly. Therefore, it’s best practice to review CARC/RARC crosswalk tables and MAC directories at least every quarter.:contentReference[oaicite:4]{index=4}
Conclusion
Understanding the n104 remark code is essential for resolving jurisdiction‑related denials in 2025. By verifying contractor mappings, keeping systems updated, and resubmitting to correct MACs, billers and coders can reduce delays and improve cash flow. For more on common denial reasons, ICD‑10 coding tips, or prior authorization workflows, visit our internal articles. Stay current with CMS updates to minimize preventable denials.