Remark Code NCLI — RENDERING PROVIDER MUST PROVIDE CLINICAL INFORMATION FOR THESE SERVICES. PLEASE SUBMIT TO: MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200, PO BOX 1121, LEWISTON, ME 04243.

Official Description RENDERING PROVIDER MUST PROVIDE CLINICAL INFORMATION FOR THESE SERVICES. PLEASE SUBMIT TO: MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200, PO BOX 1121, LEWISTON, ME 04243.

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RA835 Mapping Common Causes Resolution Steps Adjustment Group FAQ

🗂️ RA835 Mapping & EDI Details

The table below shows how Remark Code NCLI maps to the 835 Healthcare Claim Payment/Advice transaction.

Field	Value
Remark Code	NCLI
Remark Description	RENDERING PROVIDER MUST PROVIDE CLINICAL INFORMATION FOR THESE SERVICES. PLEASE SUBMIT TO: MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200, PO BOX 1121, LEWISTON, ME 04243.
RA835 Remark Code	M25
RA835 Remark Description	The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
Adjustment Group Code	CO Contractual Obligations
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 NCLI 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 NCLI:

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: CO

This remark code is associated with adjustment group code CO — Contractual Obligations.

Contractual

Payer contractual write-off; not billable to patient.

Patient Resp.

Deductible, copay, or coinsurance owed by patient.

Other Adj.

Adjustments not covered by CO or PR groups.

The active group for this code is highlighted: CO — Contractual Obligations

❓ Frequently Asked Questions

What does Remark Code NCLI mean?

RENDERING PROVIDER MUST PROVIDE CLINICAL INFORMATION FOR THESE SERVICES. PLEASE SUBMIT TO: MAINE COMMUNITY HEALTH OPTIONS, MAIL STOP 200, PO BOX 1121, LEWISTON, ME 04243. In 835 EDI transactions, this maps to RA835 remark code M25: The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.

Is Remark Code NCLI a denial or informational code?

Remark codes can be either informational or indicate a denial/adjustment. This code is associated with adjustment group CO (Contractual Obligations). Always check the accompanying CARC (Claim Adjustment Reason Code) on the remittance for the full picture.

Can I appeal a claim with Remark Code NCLI?

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 NCLI 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.