N857Remark Code (RARC)Active
N857 Remark Code - Refund Collected Copayment
The N857 code indicates that a claim has been adjusted or reversed, and it specifically instructs the provider to refund any copayment that was collected from the member. This remark serves as a reminder that the adjustment has financial implications for the patient, requiring action on the provider's part to rectify the payment received.
How It Relates to the Denial
The N857 code typically accompanies a Claim Adjustment Reason Code that explains the basis for the claim adjustment or reversal. Together, these codes signal that not only has the claim been modified, but also that any copayment made by the member needs to be refunded due to the adjustment.
Common Scenarios
1A provider billed for a service and collected a copayment from the patient, but the claim was subsequently adjusted for a different reason, leading to a total reversal of the claim.
→ In this case, the N857 code indicates that since the claim was reversed, the provider must refund the copayment previously collected from the patient.
2A claim for a procedure was denied and then later adjusted to a lower reimbursement amount, prompting a refund for the copayment that had been collected from the patient.
→ Here, the N857 remark signals that the adjustment necessitates returning the copayment to the member due to the change in claim status.
3A provider receives an 835 remittance showing that a claim for a patient visit was reversed, with an N857 remark appearing alongside a reason code indicating the claim was not payable.
→ The presence of the N857 code informs the provider that they must refund the copayment collected from the patient as part of addressing the claim's reversal.
What to Do
- Prepare to issue a refund to the member for any copayment that was collected for the reversed claim.
- Ensure that the refund process complies with the payer's guidelines for handling such adjustments.
- Document the refund transaction for your records and for any future audits.
What to Check
- Review the remittance advice for the accompanying Claim Adjustment Reason Code to understand the context of the adjustment.
- Verify the amount of the copayment collected from the member for the service in question.
- Check the patient's account to ensure the refund is processed correctly and documented.