N156Remark Code (RARC)ActiveInformational Alert
N156 Remark Code - Patient Responsibility Alert
The N156 remark code is an alert indicating that the patient is responsible for any cost difference between the approved treatment and the elective treatment they chose. This alert serves to inform the provider that a financial responsibility exists for the patient due to their treatment selection.
What This Alert Tells You
As an informational alert, N156 is not associated with any specific adjustment or denial. It typically appears on claims where elective treatments were billed, contrasting with what was approved by the payer.
Common Scenarios
1A patient opts for a higher-cost elective procedure that is not fully covered by their insurance. After billing, the claim returns with the N156 alert attached.
→ This indicates to the provider that the patient will need to cover the additional costs arising from their choice of elective treatment.
2A provider submits a claim for a cosmetic surgery that exceeds the coverage limits set by the patient's insurance plan. The remittance advice includes the N156 alert.
→ The provider is informed that the patient is liable for the difference in costs due to the elective nature of the surgery.
3A patient receives a treatment that is not the standard of care as approved by the payer, leading to an N156 alert on the claim remittance.
→ This remark informs the provider that the patient must pay any excess charges associated with their chosen treatment option.
What to Do
- Do not take any action to resubmit the claim based on this alert.
- Inform the patient about their financial responsibility regarding the elective treatment differences.
What to Check
- Review the patient's treatment plan to identify elective procedures versus approved treatments.
- Verify the patient's insurance policy for coverage details related to elective treatments.
- Check the claim details to confirm the billed items and their respective costs.