Denial Code N130: Description, Meaning and How to Fix It
The service is subject to plan restrictions; check the benefit documents.
Official description
RARC N130: Consult plan benefit documents/guidelines for information about restrictions for this service.
Common cause
Coverage limits, prerequisites, or restrictions in the plan.
How to fix it
Review the plan's benefit guidelines for the restriction, then correct billing or advise the patient accordingly.
Related denial codes
- CO-96: The service is not covered under the plan. Often paired with a RARC explaining why.
- CO-204: The item or service is not a covered benefit under this plan.
- CO-119: The patient has hit a benefit maximum (visits, dollars, or occurrences) for the period.
- PR-49: A routine or preventive service is not covered (or was billed with a routine exam), and it is patient responsibility.
- CO-45: The amount billed is higher than the payer's contracted (allowed) rate. The difference is a contractual write-off, not a patient balance.
- CO-16: The claim is missing required information or has an error. It is almost always paired with a RARC that names the specific missing field.