N722Remark Code (RARC)Active
N722 Remark Code - WCSA Funds Required for Payment
The N722 remark code indicates that the patient is required to utilize Workers' Compensation Set-Aside (WCSA) funds to cover the cost of the billed medical service or item. This remark supplements an adjustment already made by a Claim Adjustment Reason Code, clarifying the payment obligation in relation to the patient's WCSA funds.
How It Relates to the Denial
The N722 remark code typically accompanies adjustment reason codes that indicate a claim denial or reduction due to the need for WCSA funds. The combination signals that the payer expects the patient to address payment through their designated WCSA resources rather than through standard insurance benefits.
Common Scenarios
1A patient received physical therapy services following a workplace injury, and the claim was submitted to a health insurance plan.
→ The N722 remark suggests that the health insurance claim was denied because the patient should use their WCSA funds for payment instead.
2A surgical procedure was billed after a work-related incident, and the remittance included an adjustment indicating a denial of payment.
→ The N722 remark indicates that the payer expects the patient to utilize their WCSA funds to settle the costs associated with the surgery.
3A claim for durable medical equipment was submitted for a patient with a work-related injury, and the payment was adjusted down with a denial noted.
→ The presence of the N722 remark signifies that the patient is responsible for payment using WCSA funds, rather than through their regular insurance.
What to Do
- Advise the patient to use their Workers' Compensation Set-Aside funds to pay for the service or item.
- Ensure that any future claims related to the same incident account for the use of WCSA funds.
What to Check
- Review the patient’s Workers' Compensation Set-Aside fund documentation.
- Verify the Claim Adjustment Reason Code that accompanies the N722 remark for additional context.
- Check the remittance advice for any previous communications regarding WCSA obligations.