N787Remark Code (RARC)ActiveInformational Alert
N787 Remark Code - PHP Service Hour Requirement Alert
The N787 remark code indicates that under 42 CFR 410.43, an eligible Partial Hospitalization Program (PHP) patient must receive at least 20 hours of PHP services weekly, as outlined in the plan of care. This alert serves as a reminder that PHP services must be delivered in accordance with this plan.
What This Alert Tells You
The N787 alert is informational and does not accompany any specific adjustment or denial reason code. It serves to inform providers about the requirements for PHP services without indicating a claim issue.
Common Scenarios
1A provider submitted a claim for a PHP service for a patient who was noted to have received only 15 hours of service that week.
→ The N787 alert indicates that the patient did not meet the minimum service hours required for eligibility, emphasizing the need to adhere to the 20-hour weekly guideline.
2A billing office received an 835 remittance showing the N787 alert after billing for a PHP service without a corresponding denial or adjustment.
→ This alert suggests that while no payment adjustment occurred, it is essential to confirm that the patient’s service hours align with the required minimum as specified in the plan of care.
3A facility reviews its PHP claims and notices the N787 alert on multiple remittances for different patients.
→ The N787 alert highlights a common requirement across all PHP claims, indicating that the facility should ensure all patients are receiving the minimum required hours of service as part of their treatment plans.
What to Do
- Review the plan of care for PHP patients to ensure they meet the minimum service hour requirement.
- Confirm that PHP services billed align with the documented hours in the patient’s plan of care.
What to Check
- The patient’s plan of care documentation for service hour requirements.
- The service hours logged for each PHP patient to verify compliance with the 20-hour minimum.
- Any relevant clinical notes or treatment records that support the services billed.