N867Remark Code (RARC)ActiveInformational Alert
N867 Remark Code - Cost Sharing Alert Information
The N867 remark code indicates that cost sharing for a claim was calculated according to a specific state law, as required by the No Surprises Act. This alert serves as a notification to the provider that the billing practices comply with state regulations regarding patient cost sharing.
What This Alert Tells You
As an informational alert, the N867 remark code does not accompany any specific adjustment or denial reason code. It exists solely to inform providers about the basis for cost sharing calculations related to state law compliance and does not require any action on the part of the provider.
Common Scenarios
1A provider receives an 835 remittance for a patient visit where the cost sharing was adjusted based on state law requirements.
→ The N867 remark code indicates that the patient’s cost share was determined in accordance with applicable state law under the No Surprises Act, highlighting compliance with regulatory standards.
2A facility processes a claim for emergency services and sees the N867 remark on the remittance advice.
→ The presence of the N867 alert suggests that the cost sharing for the emergency services was calculated based on specific state regulations, ensuring transparency and adherence to the No Surprises Act.
3An outpatient clinic submits a claim for a service and receives an 835 with the N867 remark code included.
→ The clinic should understand that the cost sharing shown reflects calculations made per state law requirements, as mandated by the No Surprises Act, and no further action is needed.
What to Do
- Do not take any action based on this alert; it is for informational purposes only.
- Continue standard billing practices as required; the alert does not affect claim processing.
What to Check
- Review the claim details to understand the cost sharing calculations applied.
- Ensure compliance with state law as referenced by the No Surprises Act.
- Check internal billing policies to confirm alignment with the No Surprises Act requirements.