N492Remark Code (RARC)ActiveInformational Alert
N492 Remark Code - Network Provider Billing Alert
The N492 remark code is an alert indicating that a network provider has the option to bill the member for a specific service. This applies if the member requested the service and provided written consent to be financially responsible for the billed amount prior to the service being rendered.
What This Alert Tells You
As an informational alert, N492 is not associated with any adjustments or denial reasons. It serves to notify providers about the possibility of billing the member under certain circumstances, without indicating any specific payer action or adjustment.
Common Scenarios
1A patient receives a procedure that they requested from a network provider and signed a document agreeing to cover the cost beforehand. The provider submits the claim, and the remittance includes the N492 alert.
→ In this case, the N492 alert informs the provider that they may proceed to bill the patient for the service, as the required pre-approval and financial responsibility agreement are in place.
2A network provider performs a service for a member who explicitly requested it and acknowledged in writing their responsibility for payment. The claim is processed, and the N492 alert appears on the remittance advice.
→ The presence of the N492 alert indicates that the member can be billed for the service since all necessary conditions were met prior to the service being provided.
3A member requests a service from a network provider, agrees to pay for it in writing, and the provider submits the claim, which returns with the N492 alert on the remittance advice.
→ This alert indicates the provider's right to bill the member for the service rendered, confirming that the member's prior written agreement supports the billing.
What to Do
- Do not take any action to resubmit the claim based on this alert.
- If billing the member, ensure that there is documentation of the member's written agreement to be financially responsible for the service.
What to Check
- Review the member's written consent documentation to confirm the agreement to be billed.
- Check the claim submission details to ensure the service was requested by the member prior to rendering.
- Verify the service date and the billing information on the remittance advice for consistency with the member's agreement.