N885Remark Code (RARC)ActiveInformational Alert
N885 Remark Code: No Surprises Act Alert
The N885 alert indicates that the claim was not handled in compliance with the cost-sharing or out-of-network payment stipulations of the No Surprises Act. The payer has a differing opinion regarding the applicability of these requirements to your claim, which may warrant further investigation or appeal.
What This Alert Tells You
As an informational alert, the N885 remark does not accompany any specific adjustment or denial reason code. It serves to notify the provider that there is a disagreement with the claim's processing related to the No Surprises Act.
Common Scenarios
1A provider submits a claim for an emergency service rendered to a patient at an out-of-network facility, expecting protections under the No Surprises Act.
→ The N885 remark suggests that the payer does not agree that the No Surprises Act applies in this instance, which means the claim may not have been processed with the expected cost-sharing protections.
2A claim for a non-emergency service provided by an out-of-network specialist is submitted, anticipating coverage under the No Surprises Act.
→ Seeing the N885 alert indicates that the payer believes the protections of the No Surprises Act do not apply, and the claim was processed differently than expected.
3A patient receives a bill that includes charges for out-of-network services, which they believed would be covered under the No Surprises Act, leading the provider to submit an appeal.
→ The presence of the N885 remark means the payer disagrees with the claim's handling regarding the No Surprises Act, suggesting that the appeal process may be necessary to resolve the issue.
What to Do
- Do not resubmit the claim based solely on this alert.
- Consider contacting the payer to understand their reasoning for the determination.
- Prepare to appeal on behalf of the patient if necessary, following the payer’s internal appeals process.
What to Check
- Review the claim details to confirm the services rendered and their relation to the No Surprises Act.
- Examine the patient's insurance policy for any clauses regarding out-of-network services.
- Check the payer’s guidelines for processing claims under the No Surprises Act.