N801Remark Code (RARC)Active
N801 Remark Code - Medicare Facility Services Explanation
The N801 remark code indicates that the services billed were performed in a Medicare participating or Critical Access Hospital (CAH) facility under a self-insured tribal Group Health Plan, as per Federal Regulation 42 CFR 136. This remark supplements a related adjustment reason code, providing context specific to the facility type and the plan under which the services were rendered.
How It Relates to the Denial
The N801 remark code typically accompanies adjustment reason codes that relate to the payment reduction or denial due to the specific facility type where services were provided. This combination signals that the services are subject to particular regulations governing tribal health plans.
Common Scenarios
1A patient received treatment at a CAH facility under a self-insured tribal Group Health Plan, and the claim was submitted for those services.
→ The N801 remark code indicates that the services are recognized under the appropriate federal regulation, which may affect payment or coverage based on the facility type.
2A provider submits a claim for outpatient services performed at a Medicare participating facility, and the payer returns an explanation with the N801 remark code.
→ The presence of the N801 remark code suggests that the payer acknowledges the facility type, which could influence the reimbursement process under the terms of the tribal health plan.
3A claim for inpatient care at a tribal CAH is denied, and the remittance includes an adjustment reason code along with the N801 remark code.
→ The N801 remark code clarifies that the denial is linked to the services provided in a specific facility type, indicating adherence to federal regulations governing those services.
What to Do
- Verify the claim details against the federal regulation 42 CFR 136 to ensure compliance with the self-insured tribal Group Health Plan.
- Confirm that the facility type billed aligns with Medicare participation guidelines as stated in the regulation.
- Review the adjustment reason code accompanying the N801 remark to understand the specific payment implications.
What to Check
- The claim submission for accuracy regarding the facility type and service dates.
- The patient’s eligibility under the self-insured tribal Group Health Plan.
- Federal Regulation 42 CFR 136 to ensure that all services rendered comply with its requirements.