N116Remark Code (RARC)ActiveInformational Alert
N116 Remark Code - Conditional Payment Alert
The N116 remark code indicates that the payment is conditional due to the service being provided in the home. It suggests that the patient may be under a home health episode of care, which could affect how payment is processed due to consolidated billing rules.
What This Alert Tells You
This alert remark typically accompanies payments for services rendered in the home setting. It serves as a warning that if the patient is indeed receiving care under a home health agency, certain services may need to be billed through that agency instead.
Common Scenarios
1A physical therapy session was billed for a patient treated at home, and the payment received included the N116 remark.
→ The presence of N116 indicates that while payment is being made, there is a possibility that the patient is also receiving home health services that could require recoupment of this payment.
2A nurse visit was billed for a patient at home, and the remittance shows the N116 alert remark.
→ This means the payer is alerting you that the payment made may need to be returned if it is determined the patient is under an active home health episode.
3An occupational therapy service was provided in a patient's home, and the claim included the N116 remark upon payment.
→ The remark suggests that the payer is flagging this payment as conditional, pending verification of any concurrent home health agency involvement.
What to Do
- Do not resubmit the claim based on this alert alone; it does not require action.
- Monitor for any further communication from the payer regarding the patient's home health status.
What to Check
- Check the patient's eligibility and benefit information to confirm any ongoing home health episodes.
- Review the documentation of services provided to ensure compliance with home health billing regulations.
- Look for any notifications from the home health agency regarding the patient's care status.