N855Remark Code (RARC)Active
N855 Remark Code - ERISA Coverage Jurisdiction
The N855 remark code indicates that the claim is associated with coverage that falls under the exclusive jurisdiction of ERISA (1974), specifically referencing U.S.C. SEC 1001. This remark supplements an adjustment already noted by an accompanying Claim Adjustment Reason Code, providing additional context about the legal framework governing the coverage related to the claim.
How It Relates to the Denial
The N855 remark typically accompanies adjustment reason codes that signal coverage issues or legal jurisdiction matters. This combination suggests that the payer is indicating the claim's relationship to ERISA regulations, which may affect how the claim is processed or appealed.
Common Scenarios
1A provider submits a claim for a medical procedure performed on a patient with ERISA-covered insurance. The remittance advises an adjustment with a claim adjustment reason code indicating a payment issue due to jurisdiction.
→ In this case, the N855 remark clarifies that the payment issue is due to the fact that the coverage is governed by ERISA, which may have specific implications for the claim's processing.
2A claim for durable medical equipment is submitted, and the remittance shows an adjustment reason code for non-payment. The N855 remark is included in the remittance advice.
→ This indicates that the equipment claim is subject to ERISA jurisdiction, suggesting the payer may have specific requirements or limitations based on ERISA regulations.
3A hospital submits a claim for outpatient services and receives a remittance with an adjustment reason code related to coverage denial. The N855 code appears as a supplementary remark.
→ The N855 remark informs the provider that the denial is linked to ERISA jurisdiction, which could necessitate a review of compliance with ERISA guidelines or appeal processes.
What to Do
- Review the accompanying claim adjustment reason code for context on the adjustment.
- If appealing, ensure that any appeal documentation references ERISA compliance as noted in the N855 remark.
What to Check
- The claim adjustment reason code that accompanies N855 for specific details on the adjustment.
- ERISA guidelines to understand any implications for the claim being processed under this jurisdiction.
- The patient's insurance policy to confirm it falls under ERISA coverage.