N804Remark Code (RARC)ActiveInformational Alert
N804 Remark Code - Outpatient Code Editor Alert
The N804 remark code indicates that the claim or service has been processed through the Outpatient Code Editor (OCE). This alert serves as a notification that the claim underwent specific coding validations typically associated with outpatient services.
What This Alert Tells You
As an informational alert, the N804 remark code is not tied to any adjustments or denials. It merely informs the provider that the claim has passed through the OCE, which is a standard procedure for outpatient billing.
Common Scenarios
1A facility submitted a claim for outpatient surgery services, and the 835 remittance included the N804 remark code.
→ In this case, the N804 alert indicates that the claim was evaluated by the OCE, which checks coding compliance and ensures appropriate billing practices for outpatient services.
2A provider received a remittance for a series of outpatient diagnostic tests with the N804 remark on the 835.
→ The presence of the N804 alert informs the provider that the claim processing included the OCE, confirming adherence to outpatient coding standards.
3An outpatient therapy claim was submitted, and the remittance advice indicated N804 along with payment details.
→ Here, the N804 alert signifies that the claim went through the OCE, ensuring that the coding met the necessary outpatient criteria.
What to Do
- Do not take any action based on this remark code.
- Expect that this is simply an informational note regarding the claim's processing.
What to Check
- Review the claim details to understand how the OCE might have influenced processing.
- Check the coding applied to the claim to ensure it aligns with outpatient coding guidelines.
- Consult any relevant coding manuals that outline OCE procedures for outpatient services.