Remark Code
JP07
Remark Code
RA835: N35
OA — Other Adjustments
Remark Code JP07 — Payment Integrity program review - Illegible documentation
Official Description
Payment Integrity program review - Illegible documentation
🗂️ RA835 Mapping & EDI Details
The table below shows how Remark Code JP07 maps to the 835 Healthcare Claim Payment/Advice transaction.
| Field | Value |
|---|---|
| Remark Code | JP07 |
| Remark Description | Payment Integrity program review - Illegible documentation |
| RA835 Remark Code | N35 |
| RA835 Remark Description | Program integrity/utilization review decision. |
| Adjustment Group Code | OA OA Other adjustments |
| Adjustment Reason Code | 16 |
| Adjustment Reason Description | Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
📋 Usage Note
Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
⚠️ Common Causes
Remark Code JP07 typically appears on an Explanation of Benefits (EOB) or remittance advice for the following reasons:
- 1The submitted diagnosis code is not consistent with the provider's specialty or type.
- 2Missing, incomplete, or invalid secondary/other diagnosis codes on the claim.
- 3The procedure billed does not align with the diagnosis codes provided.
- 4Incorrect or outdated ICD code used for the given service date.
- 5Payer policy requires additional documentation supporting the diagnosis.
✅ Resolution Steps
Follow these steps to resolve a claim denied or adjusted with Remark Code JP07:
- 1Review the original claim and verify all diagnosis codes are accurate and current (ICD-10-CM).
- 2Confirm the diagnosis is appropriate for your provider type and specialty.
- 3Check for any missing or incomplete secondary diagnosis fields and resubmit corrected data.
- 4Consult the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) if present for payer-specific guidance.
- 5If the denial appears incorrect, gather supporting clinical documentation and file an appeal with the payer within the timely filing window.
- 6Contact the payer's provider relations line for clarification if the reason remains unclear after review.
🏷️ Adjustment Group: OA
This remark code is associated with adjustment group code OA — Other Adjustments.
CO
Contractual
Payer contractual write-off; not billable to patient.
PR
Patient Resp.
Deductible, copay, or coinsurance owed by patient.
OA
Other Adj.
Adjustments not covered by CO or PR groups.
The active group for this code is highlighted: OA — Other Adjustments
❓ Frequently Asked Questions
What does Remark Code JP07 mean?
Payment Integrity program review - Illegible documentation In 835 EDI transactions, this maps to RA835 remark code N35: Program integrity/utilization review decision.
Is Remark Code JP07 a denial or informational code?
Remark codes can be either informational or indicate a denial/adjustment. This code is associated with adjustment group OA (Other Adjustments). Always check the accompanying CARC (Claim Adjustment Reason Code) on the remittance for the full picture.
Can I appeal a claim with Remark Code JP07?
Yes. If you believe the remark was applied incorrectly, you may file an appeal with supporting clinical documentation. Review the payer's appeal guidelines and ensure you file within the timely filing deadline specified in your contract.
What is the difference between a Remark Code and a Denial Code?
A Denial Code (CARC — Claim Adjustment Reason Code) explains why a payment was reduced or denied. A Remark Code provides supplemental information to clarify the adjustment — they often appear together on the same remittance line.
Where do I find Remark Code JP07 on the remittance?
On an 835 ERA, look in loop 2110 (Service Payment Information) under the RMK segment. On a paper EOB it typically appears in the "Remark" or "Message" column alongside the service line.
Disclaimer: The information on this page is provided for educational purposes only and reflects general industry guidance. Always verify codes and policies directly with the payer or consult a certified medical billing professional for claims-specific advice.