N895Remark Code (RARC)Active
N895 Remark Code - Specialty Drug Program Fee Schedule
The N895 remark code indicates that the claim was processed according to a negotiated fee schedule specifically for a specialty drug program. This means the payment reflects a pre-established agreement regarding the reimbursement rates for specialty drugs rather than standard fee schedules.
How It Relates to the Denial
The N895 remark typically accompanies adjustment reason codes that explain a reduced payment amount due to the application of a specialty drug program. This combination signals that the claim was not denied, but rather processed under specific financial guidelines that may differ from usual billing practices.
Common Scenarios
1A provider submits a claim for a specialty drug administered in an outpatient setting, and the remittance shows a lower payment than expected.
→ In this case, the N895 remark code clarifies that the payment was aligned with a negotiated fee schedule for specialty drugs, which may be less than the usual billed amount.
2A physician bills for a high-cost specialty medication, but the reimbursement is significantly reduced, leading to confusion on the billing desk.
→ The appearance of the N895 remark code indicates that the payment adjustment is due to the negotiated rates specifically for specialty drugs, rather than an outright denial or error.
3A pharmacy submits a claim for a specialty drug and receives an explanation of benefits that shows a payment amount lower than the billed charge.
→ The N895 remark informs the pharmacy that the claim was processed based on an agreed-upon fee schedule under a specialty drug program, which accounts for the reduced payment.
What to Do
- Review the negotiated fee schedule for specialty drugs to understand the payment amount.
- Ensure that the service billed aligns with the definitions outlined in the specialty drug program agreement.
- Document the payment adjustment and communicate with the provider if further clarification is needed.
What to Check
- The specialty drug program policy to confirm negotiated rates.
- The original claim submission for accuracy in billed services.
- The adjustment reason codes accompanying the N895 remark for additional context.