N69Remark Code (RARC)ActiveInformational Alert
N69 Remark Code - PPS Code Changed Alert
The N69 remark code indicates that the Prospective Payment System (PPS) code associated with a claim has been altered by the claims processing system. This alert serves as a notification to providers that their submitted PPS code may not match the one processed by the payer, potentially affecting payment calculations.
What This Alert Tells You
The N69 alert remark is informational and does not accompany any adjustments or denials. It is intended to inform providers of changes made to PPS codes without implying any action is required on the claim.
Common Scenarios
1A hospital submits a claim for inpatient services using a specific PPS code, but the remittance advice returns with the N69 alert.
→ In this scenario, the N69 remark is indicating that the payer has modified the PPS code during processing. The provider should review the claim to understand the implications of this change.
2A skilled nursing facility bills for a patient under a certain PPS code, and the payment remittance shows an N69 alert.
→ The appearance of the N69 alert suggests that the payer adjusted the PPS code, which may impact reimbursement. The facility should verify the PPS code used to ensure it aligns with the payer's processing.
3An outpatient therapy provider files a claim with a specific PPS code, receiving an N69 alert on the remittance advice.
→ The N69 alert indicates that the claims processing system has altered the PPS code, signaling the provider to check the accuracy of the billed code against the payer's guidelines.
What to Do
- Do not take any action on the claim in response to this alert.
- Monitor future remittance advices for any additional information regarding the PPS code adjustments.
What to Check
- Review the original claim submission for the PPS code used.
- Consult the payer's guidelines on PPS coding to understand potential variations.
- Check for any updates or notices from the payer regarding PPS code changes.