N872Remark Code (RARC)ActiveInformational Alert
N872 Remark Code - No Surprises Act Payment Alert
The N872 remark code indicates that the final payment issued was calculated in accordance with a specified state law, as outlined in the No Surprises Act. This alert serves to inform providers that the payment has been determined under specific legal guidelines, rather than through standard contractual negotiations or usual payment processes.
What This Alert Tells You
The N872 alert is informational and does not accompany any specific adjustment or denial. It is used to convey that the payment adheres to regulatory requirements, indicating compliance with the No Surprises Act.
Common Scenarios
1A provider submits a claim for emergency services rendered to a patient with out-of-network benefits. The payment received includes the N872 remark code.
→ In this case, the N872 remark signals that the payment amount reflects calculations mandated by state law related to the No Surprises Act, ensuring the provider is aware of the legal basis for the payment.
2A claim for a surprise billing situation is processed, and the remittance advises that the payment corresponds with the N872 alert.
→ This alert informs the provider that the payment was made based on statutory guidelines, emphasizing that the payment methodology was influenced by legal requirements rather than standard billing practices.
3A hospital receives an 835 remittance for a claim involving a patient who was treated without prior authorization, accompanied by the N872 remark code.
→ Here, the N872 remark indicates that despite the lack of authorization, the payment is compliant with the No Surprises Act, highlighting the protections afforded to the patient and the payment determination process.
What to Do
- Do not resubmit the claim based on this remark, as it is informational only.
- Continue to follow standard billing practices for future claims.
- Be aware of the implications of the No Surprises Act for future billing and payment scenarios.
What to Check
- Review the claim details to understand the services provided and payment received.
- Check the payer's policy documentation regarding the No Surprises Act and state law compliance.
- Verify any applicable state regulations that may affect payment calculations.