N861Remark Code (RARC)ActiveInformational Alert
N861 Remark Code - Patient Liability Mismatch Alert
The N861 remark code indicates that there is a mismatch between the Patient Liability or Share of Cost amount submitted on the claim and the amount recorded for the recipient. This alert serves to inform the biller that the payer has noted a discrepancy and that the billed amount may not align with the payer's records.
What This Alert Tells You
As an informational alert, the N861 remark code is not associated with any specific adjustment or denial. It appears in remittance advice to flag potential issues regarding patient liability amounts without affecting payment status.
Common Scenarios
1A provider submits a claim for a service rendered to a patient, including a Patient Liability amount of $50. The remittance advice returns with the N861 remark code.
→ The N861 alert suggests that the payer's records show a different Patient Liability amount for this recipient, prompting the provider to verify the accuracy of the billed amount.
2After billing for a procedure, a provider receives an ERA indicating an N861 remark code, which states a discrepancy in the Share of Cost reported for the patient.
→ This alert indicates that the payer's recorded Share of Cost does not match what was submitted, signaling to the provider to review the patient's liability details.
3A claim for a patient includes a Patient Liability of $30, but the remittance shows an N861 remark code during the payment process.
→ The N861 alert highlights that the submitted Patient Liability amount of $30 does not match the payer's records, indicating a need for further investigation.
What to Do
- Do not take any action based on this alert; it is informational only.
- Review the patient's liability records to ensure accuracy in future submissions.
What to Check
- The patient's eligibility and benefits documentation to verify the correct Patient Liability amount.
- Any prior communications or agreements with the payer regarding the Share of Cost for the patient.
- The claim details submitted to ensure the amounts align with patient records.