N876Remark Code (RARC)ActiveInformational Alert
N876 Remark Code: Coverage Alert Under No Surprises Act
The N876 code is an informational alert indicating that the item or service is covered under the plan. It also signifies a denial of payment according to the No Surprises Act, allowing the provider to negotiate a higher out-of-network rate if desired.
What This Alert Tells You
As an alert remark code, N876 is not tied to any specific adjustment or reason code. It serves as a reminder of coverage while also informing providers of their rights under the No Surprises Act concerning out-of-network negotiations.
Common Scenarios
1A provider submits a claim for an out-of-network service, and the patient receives a notice indicating that the service is covered under their plan.
→ The N876 alert suggests that even though there was a denial of payment, the service is indeed covered, allowing the provider the option to negotiate for a higher payment.
2A facility bills for a procedure performed on a patient who is out-of-network, and the remittance response includes the N876 alert.
→ This alert informs the facility that the service is covered by the patient's insurance plan, but payment has been denied, prompting the facility to consider negotiating a higher rate.
3A claim for a covered service is denied, and the remittance advice includes the N876 remark for the provider's review.
→ The N876 alert indicates that while the claim was denied, the service remains covered under the patient's plan, and the provider may pursue negotiation options.
What to Do
- Do not resubmit the claim as the alert is informational only.
- Consider initiating open negotiations for a higher out-of-network payment if applicable.
What to Check
- Review the patient's plan benefits to confirm coverage for the service.
- Check the patient's cost-sharing amounts to understand the payment dynamics.
- Examine the provided remittance advice for additional details on the payment denial.