N615Remark Code (RARC)ActiveInformational Alert
N615 Remark Code - Grace Period Information
The N615 alert indicates that the enrollee is currently in a grace period of three consecutive months due to non-payment of their premium, yet is receiving advance payments of the premium tax credit. During the first month of this grace period, the issuer is required to pay all appropriate claims for services rendered to the enrollee, while they may choose to pend claims for the second and third months of the grace period.
What This Alert Tells You
The N615 alert is informational and is not tied to any specific adjustment or denial. It typically accompanies claims that are submitted for enrollees in a grace period, indicating the payment obligations of the issuer during that time.
Common Scenarios
1A healthcare provider submitted a claim for an enrollee who is receiving advance payments of the premium tax credit and is in a grace period due to missed premium payments.
→ The N615 alert informs the provider that the payer must cover claims for services rendered during the first month of the grace period, while any claims for subsequent months may be pending.
2A medical facility billed for services provided to a patient who is in a grace period for non-payment of premiums and received an EOB with the N615 alert.
→ The N615 alert indicates that the facility should expect payment for the first month's services, but claims for the following months may not be processed immediately.
3A biller is reviewing remittance advice for a patient who has been receiving advance premium tax credits and notices the N615 alert on multiple claims.
→ The N615 alert serves as a reminder that while the patient is in a grace period, payment for services in the first month is guaranteed, but the status of claims for later months may be uncertain.
What to Do
- Do not take any action on claims related to the first month of the grace period, as they should be paid by the issuer.
- Monitor claims submitted for the second and third months of the grace period, as these may be pended or denied.
What to Check
- Review the enrollee's payment history to confirm the grace period status.
- Check the plan benefits document for details on grace period claims processing.
- Examine the claim submission dates to determine which month of the grace period the services fall under.