N878Remark Code (RARC)ActiveInformational Alert
N878 Remark Code - Balance Billing Compliance Alert
The N878 alert informs billers that while the provider indicated notice was given and consent to balance bill was obtained, this process did not comply with applicable Federal law. As a result, the payer has calculated cost sharing and total amounts based on the No Surprises Act, prohibiting balance billing.
What This Alert Tells You
This alert is not tied to any specific adjustment or reason code but serves as an important notification regarding compliance with balance billing laws. It typically appears in situations involving claims where balance billing was attempted without proper notice and consent.
Common Scenarios
1A patient received an out-of-network service, and the provider attempted to balance bill them after indicating consent was obtained.
→ The N878 alert indicates that the provider's notice and consent process did not meet Federal law requirements, leading to the payer's calculation of amounts under the No Surprises Act.
2A facility provided emergency services and notified the patient of potential balance billing, but did not follow the required legal process for consent.
→ The presence of the N878 alert indicates that the facility's notice was insufficient according to Federal law, and the payer is enforcing No Surprises Act protections.
3A claim for a specialty service was submitted with a note stating that the patient consented to balance billing, but the payer flagged the submission with an N878 alert.
→ The N878 alert suggests that the consent process was not compliant with legal standards, and the payer will not allow balance billing in this case.
What to Do
- Do not take any action to resubmit the claim related to this alert, as it is informational only.
- Review the notice and consent process used for balance billing to ensure compliance with Federal law moving forward.
What to Check
- Examine the documentation of notice and consent provided to the patient for balance billing.
- Verify the compliance of the balance billing process with the No Surprises Act requirements.
- Check any correspondence or records that detail the patient’s understanding and acknowledgment of potential costs.