N914Remark Code (RARC)Active
N914 Remark Code - California AB-72 Pricing Explained
The N914 remark code indicates that the claim was evaluated and compensated based on the regulations set forth by California AB-72 for health care coverage. This means the payment and processing of the claim adhered to specific state guidelines designed to protect patients from surprise medical bills.
How It Relates to the Denial
Typically, N914 accompanies a Claim Adjustment Reason Code that relates to payment adjustments under California AB-72 regulations. This combination signals that the claim's processing aligns with state law requirements for pricing and coverage.
Common Scenarios
1A provider submitted a claim for emergency services received by a patient at an out-of-network facility in California. The remittance returned with a payment adjustment and the N914 remark.
→ The presence of N914 suggests that the claim was processed in compliance with California AB-72, which governs how out-of-network emergency services are billed and reimbursed.
2A claim for a surgical procedure performed by an out-of-network specialist was submitted, and the remittance included a payment reduction along with the N914 remark code.
→ The N914 remark indicates the payment was calculated according to California AB-72, which may influence the allowable charges and reimbursement rates for out-of-network providers.
3A patient received treatment from a non-contracted provider during an emergency, and the claim was submitted with a request for full coverage. The remittance indicated a reduced payment and included the N914 remark.
→ The N914 remark signifies that the claim pricing was determined in accordance with California AB-72, reflecting the patient's rights under state law regarding emergency care.
What to Do
- Verify that the claim was submitted correctly under California AB-72 guidelines.
- Ensure that the pricing aligns with the requirements specified in the state's health care coverage regulations.
- If necessary, appeal the adjustment by referencing AB-72 compliance.
What to Check
- Review the claim details to confirm the services rendered fall under California AB-72.
- Check the payer's policies regarding AB-72 to understand the pricing framework used.
- Examine the accompanying Claim Adjustment Reason Code for specific adjustment details.