N364Remark Code (RARC)ActiveInformational Alert
N364 Remark Code - Waive Deductible/Coin Insurance Alert
The N364 remark code alerts the biller that, per the agreement with the payer, the deductible and/or coinsurance amounts must be waived. This means the provider is expected to absorb these costs rather than collecting them from the patient.
What This Alert Tells You
The N364 alert is informational and does not accompany any specific adjustment or reason code. It serves as a reminder of the contractual obligation regarding patient cost-sharing responsibilities.
Common Scenarios
1A provider submits a claim for a procedure that typically has a deductible and coinsurance. Upon processing, the remittance advice includes the N364 remark code.
→ In this situation, the N364 code indicates that the provider must not charge the patient for the deductible or coinsurance, as stipulated in their agreement with the payer.
2A billing office reviews an 835 remittance for a patient who underwent a service with associated coinsurance. The N364 code appears on the remittance advice.
→ This alerts the billing office that they should not collect the coinsurance from the patient due to the agreement in place with the payer.
3After processing a claim for a diagnostic service, the remittance advice lists the N364 remark code, indicating a waiver was expected.
→ The presence of the N364 code informs the billing staff that they are required to waive any applicable deductible or coinsurance for that service based on the contractual agreement.
What to Do
- Do not attempt to collect the deductible or coinsurance from the patient for claims affected by this alert.
- Ensure that billing practices align with the payer's requirements regarding waiving patient cost-sharing.
What to Check
- Review the provider's agreement with the payer to confirm obligations regarding deductibles and coinsurance.
- Check the specific service or procedure billed to understand if it falls under the waiver requirements outlined in the agreement.
- Verify any prior communications or policies from the payer that detail the waiver of patient costs.