N859Remark Code (RARC)ActiveInformational Alert
N859 Remark Code - No Surprise Billing Act Alert
The N859 remark code indicates that the Federal No Surprise Billing Act was applied during the processing of the claim. This alert informs the provider that payment amounts can be disputed under any applicable federal appeal or grievance resolution processes.
What This Alert Tells You
As an informational alert, N859 is not associated with any specific adjustment or reason code. It serves to notify providers of their rights regarding payment disputes under the No Surprise Billing Act.
Common Scenarios
1A provider receives an 835 remittance for a claim involving emergency services, and the payment amount seems lower than expected.
→ The N859 alert suggests that the Federal No Surprise Billing Act was applied, which may provide grounds for the provider to dispute the payment amount.
2A facility submits a claim for a patient treated out-of-network and receives a remittance with the N859 alert indicating the application of the No Surprise Billing Act.
→ This remark indicates that the claim was processed under federal law, allowing the facility to pursue a dispute if they believe the payment is inadequate.
3A provider sees the N859 remark on a remittance for a scheduled procedure that was performed at an out-of-network facility.
→ The alert indicates that the No Surprise Billing Act applies, and the provider can potentially appeal the payment amount based on federal guidelines.
What to Do
- Do not resubmit the claim based solely on this alert; it is for informational purposes.
- Consider reviewing the payment amount in the context of the No Surprise Billing Act and determine if a dispute is warranted.
What to Check
- Review the federal No Surprise Billing Act documentation for guidelines on dispute resolution processes.
- Check the specific details of the claim that generated the N859 alert to understand the payment context.
- Consult any communication from the payer regarding the application of the No Surprise Billing Act to the claim.