N88Remark Code (RARC)ActiveInformational Alert
N88 Remark Code - Conditional Payment Alert
The N88 alert indicates that the payment for the claim is conditional because an episode of care notice for Home Health Agency (HHA) services has been filed for the patient. It warns that certain therapy services and supplies associated with the claim may need to be recouped if it is determined that the patient is receiving concurrent treatment under an HHA episode of care.
What This Alert Tells You
The N88 alert typically accompanies claims that involve therapy services and supplies that fall under consolidated billing rules for HHA episodes of care. This alert serves as a notification rather than a denial, indicating that the payer is flagging the claim for potential future recoupment.
Common Scenarios
1A patient receiving physical therapy is also enrolled in an HHA program, and the claim for therapy services is submitted. Upon processing, the payment is received with the N88 alert.
→ The N88 alert informs the billing office that while payment was made, it is conditional based on the patient's concurrent HHA treatment, and future recoupment could occur.
2A claim for occupational therapy services is processed and a payment is issued, accompanied by the N88 alert. The patient has an ongoing HHA episode of care.
→ The N88 alert indicates that the payment is made with the understanding that it may need to be recouped if the HHA billing rules apply to the services provided.
3An invoice for speech therapy services is sent for a patient who is also receiving HHA care. The remittance advice includes the N88 alert, indicating conditional payment.
→ The N88 alert serves as a caution that while the payment has been made, there is a possibility of recoupment if it is confirmed that the patient is under an HHA episode of care.
What to Do
- Do not resubmit the claim at this time; the payment is conditional based on future determinations.
- Monitor future remittances for any adjustments or recoupments related to this alert.
What to Check
- Verify if the patient is currently receiving treatment under an HHA episode of care.
- Review the claim details to confirm the services billed fall under the HHA consolidated billing rules.
- Check the patient's eligibility and benefit documents related to HHA services.