N854Remark Code (RARC)ActiveInformational Alert
N854 Remark Code - Appeal Requirements for OHI Claims
The N854 remark code serves as an alert to providers regarding claims with primary other health insurance (OHI) coverage. It informs billers that all appeal levels with the primary OHI must be exhausted before the payer will consider reimbursement for the claim.
What This Alert Tells You
As an informational alert, N854 is not associated with any specific adjustment or denial reason codes. It serves to remind providers of the necessary steps to take regarding claims with OHI coverage.
Common Scenarios
1A provider submitted a claim for a service rendered to a patient who has primary other health insurance. The claim was returned with the N854 remark code.
→ The N854 code indicates that the payer is awaiting confirmation that all appeal processes with the primary OHI have been completed before they will review the claim for payment.
2A medical facility billed for a procedure covered under a patient's primary OHI, but the OHI denied the claim. The facility received the N854 remark code on the remittance advice.
→ The presence of the N854 remark code indicates that the medical facility must first resolve the denial with the primary OHI before the payer will consider their claim.
3An outpatient clinic submitted a claim for a patient's visit, but the response included the N854 alert. The clinic had not yet appealed the OHI's denial.
→ The N854 alert signals to the clinic that they need to exhaust all appeal options with the primary OHI before the payer can take any action on their claim.
What to Do
- Do not resubmit the claim until all appeal levels with the primary OHI have been exhausted.
- Ensure that documentation of the appeal process with the primary OHI is available for reference.
What to Check
- Review the appeal status with the primary OHI and confirm that all levels have been addressed.
- Check the patient's primary OHI policy details to ensure compliance with their appeal process.
- Verify the claim submission dates to ensure timelines align with appeal requirements.