N862Remark Code (RARC)ActiveInformational Alert
N862 Remark Code - Member Cost Share Compliance Alert
The N862 remark code indicates that the member's cost share complies with the No Surprises Act. It specifies that the cost share was calculated based on the lesser amount between the Qualified Payment Amount (QPA) and the billed charge.
What This Alert Tells You
As an informational alert, the N862 remark code appears alongside claims where cost sharing adheres to the No Surprises Act. It does not correspond to any specific adjustments or denials, serving purely to communicate compliance details.
Common Scenarios
1A patient received emergency care at an out-of-network facility, and the claim was submitted for the services rendered.
→ The N862 remark indicates that the patient’s cost share was appropriately calculated in accordance with the No Surprises Act, ensuring they were not charged more than the QPA or billed amount.
2A claim for a surgical procedure was processed, and the patient's statement included a cost share amount that seemed lower than expected.
→ The presence of the N862 remark confirms that the cost share aligns with the No Surprises Act, reinforcing that the calculation followed the required guidelines.
3A claim for a specialist visit was submitted, and the remittance advice included the N862 alert without any associated adjustments.
→ In this case, the N862 remark assures that the member's cost responsibilities were computed correctly, adhering to the regulations set forth by the No Surprises Act.
What to Do
- Do not take any specific action regarding this remark, as it is informational only.
- Expect that the cost share has been calculated correctly in accordance with the No Surprises Act.
What to Check
- Review the claim details to confirm the billed charge and QPA amounts.
- Check the patient’s cost share amount to ensure it reflects compliance with the No Surprises Act.
- Verify any applicable patient agreements or disclosures related to cost sharing.