EOB denial code N130: what it means

What it means

The insurer is pointing you to your plan documents to understand the coverage restrictions that applied to this service.

Official X12 description

“Consult plan benefit documents/guidelines for information about restrictions for this service.”

Typical cause

Attached to an adjustment where a plan-specific limit or restriction affected payment.

What to do next

1. 1Review your Summary of Benefits and Coverage and plan documents for restrictions on this service.
2. 2Decode the CARC reported alongside this remark to see the specific adjustment reason.