N860Remark Code (RARC)ActiveInformational Alert
N860 Remark Code: QPA Used for Member Cost Share
The N860 remark code indicates that the Federal No Surprise Billing Act Qualified Payment Amount (QPA) was utilized to determine the member's cost share. This alert serves as a notification regarding the methodology used in calculating the patient's financial responsibility, ensuring compliance with the No Surprise Billing Act.
What This Alert Tells You
As an informational alert, the N860 remark code is not associated with any specific adjustment or denial. It is provided to clarify that the QPA was applied in the claims process, which is relevant for understanding patient billing.
Common Scenarios
1A patient receives a surprise medical bill for an out-of-network emergency service. The claim processed includes the N860 remark code.
→ In this case, the N860 remark code informs the provider that the QPA was applied when determining the patient's cost share, aligning with the requirements of the No Surprise Billing Act.
2A provider submits a claim for a procedure performed by an out-of-network specialist, and the remittance advice includes the N860 alert.
→ Here, the N860 remark signifies that the QPA was used to calculate the member's out-of-pocket costs, which is crucial for the provider's understanding of the billing process under the new regulations.
3An insurance company processes a claim for a non-emergency service provided out-of-network, and the N860 code appears on the remittance advice.
→ This indicates that the cost share for the member was calculated using the QPA, highlighting the payer's adherence to the No Surprise Billing Act.
What to Do
- Do not take any action based on this alert as it is informational only. Expect that the QPA was correctly applied in determining member cost shares.
What to Check
- Review the details of the claim to understand the QPA calculations.
- Check the patient's cost share breakdown to ensure clarity on their financial responsibility.
- Verify compliance with the No Surprise Billing Act in the billing practices.