N875Remark Code (RARC)ActiveInformational Alert
N875 Remark Code: Out-of-Network Rate Payment Alert
The N875 remark code indicates that the final payment made for a claim matches the out-of-network rate determined by a Federal Independent Dispute Resolution Entity, as mandated by the No Surprises Act. This alert serves as a notification regarding the payment amount rather than a denial or adjustment to the claim.
What This Alert Tells You
As an informational alert, the N875 code is not associated with any specific adjustment or denial but rather provides clarity about the payment calculation process under the No Surprises Act. It highlights that the payer has resolved a dispute concerning out-of-network billing rates.
Common Scenarios
1A provider submits a claim for an emergency service rendered to a patient who is out-of-network. Upon receiving the payment, the provider notices the N875 remark on the remittance advice.
→ In this case, the N875 remark indicates that the payment received aligns with the out-of-network rate as determined by a Federal Independent Dispute Resolution Entity, affirming compliance with the No Surprises Act.
2A biller reviews an 835 remittance advice for a surgical procedure performed by an out-of-network provider. The remittance includes the N875 alert along with the payment details.
→ The N875 alert informs the biller that the payment amount is consistent with the out-of-network rate established through a dispute resolution process, ensuring that the payment follows the guidelines set by the No Surprises Act.
3A healthcare organization receives an 835 indicating a payment for a non-emergency service rendered out-of-network, accompanied by the N875 remark code.
→ This remark signifies that the payment corresponds to the out-of-network rate determined by a Federal Independent Dispute Resolution Entity, indicating the payer's adherence to the No Surprises Act.
What to Do
- Do not take any further action based on this alert, as it does not indicate a denial or require resubmission of the claim.
What to Check
- Review the payment amount to confirm it aligns with the out-of-network rate specified by the Federal Independent Dispute Resolution Entity.
- Check the claim details against the No Surprises Act provisions to understand the implications of the payment received.