N604Remark Code (RARC)Active
N604 Remark Code - New York No-Fault Fee Adjustment
The N604 remark code indicates that the billed amount has been adjusted based on the New York No-Fault Law, specifically referencing the calculation of fees in accordance with the New York Workers' Compensation Board Schedule. It clarifies that the base fee for the service was determined under Regulation 68, which is part of broader regulatory guidelines.
How It Relates to the Denial
Typically, N604 will accompany a Claim Adjustment Reason Code related to fee adjustments under New York's workers' compensation regulations. The combination signals that the payment made reflects these state-specific fee schedules and regulations.
Common Scenarios
1A provider submitted a claim for physical therapy services for a patient injured in a motor vehicle accident, billing for a higher base fee than what was allowed.
→ The N604 remark shows that the adjustment was made to align with the New York Workers' Compensation Board's fee schedule, indicating that the billed amount exceeded the allowable fee under state regulations.
2A claim for an orthopedic consultation was submitted, and the remittance showed a reduced payment with the N604 remark attached.
→ This indicates that the payment adjustment corresponds to the fee calculated as per the New York No-Fault Law, signaling that the provider needs to accept the reduced amount based on established state regulations.
3A claim for diagnostic imaging was denied for exceeding the allowable amount, and the remittance included N604 along with a reason code for adjustment.
→ The N604 remark clarifies that the adjustment is due to the application of the New York Workers' Compensation Board Schedule of Medical Fees, thus explaining the reduction in payment.
What to Do
- Review the claim to ensure that the billed amount aligns with the New York Workers' Compensation Board Schedule of Medical Fees.
- If necessary, adjust the billing to reflect the allowable amounts according to the state regulations.
What to Check
- The New York Workers' Compensation Board Schedule of Medical Fees for applicable services.
- The original claim submission details to confirm the billed amount.
- The accompanying Claim Adjustment Reason Code to understand the specific adjustment made.