N114Remark Code (RARC)Active
N114 Remark Code: Ambulance Fee Schedule Payment Explanation
The N114 remark code indicates that during the transition to the Ambulance Fee Schedule, the payment for ambulance services is determined by a blended calculation. This calculation uses either a percentage of the reasonable charge or cost along with fee schedule amounts, or it may be based on the submitted charge, whichever is lower.
How It Relates to the Denial
The N114 remark code typically accompanies adjustment reason codes related to payment reductions for ambulance services. This combination signals that the claim payment is affected by the transition rules of the Ambulance Fee Schedule.
Common Scenarios
1A claim for an ambulance transport service is submitted at a charge of $1,200. The remittance shows a payment of $800 with the accompanying reason code indicating a payment adjustment.
→ The N114 remark code suggests that the payment of $800 was determined using the blended calculation, which was lower than the submitted charge of $1,200.
2A provider bills for an emergency ambulance service, and the remittance advises of a payment based on a fee schedule amount lower than the billed amount.
→ In this case, the N114 remark code clarifies that the payment is calculated based on the lesser of the blended amount or the submitted charge, consistent with the transition to the Ambulance Fee Schedule.
3An ambulance service provider receives a remittance that shows a payment amount significantly lower than expected, along with an adjustment reason code for fee schedule application.
→ The presence of the N114 remark code indicates that the payment was calculated using the blended payment method during the transition to the Ambulance Fee Schedule, explaining the reduction.
What to Do
- Review the adjustment reason code to understand the initial payment determination.
- Verify the blended payment calculation method used by the payer for this service.
- Check for any annual notifications from the payer regarding changes to the blended percentages.
What to Check
- The original claim submission details, including the billed amount.
- The payer's fee schedule for ambulance services to understand the calculated amount.
- Previous remittance advices for any updates on the blended payment percentages.