How To Fix Remark Code M1061 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N866 means that the claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services. This code serves as an alert to healthcare providers and insurance companies regarding the specific regulations and requirements related to air ambulance services provided by nonparticipating providers.

1. Description

Remark Code N866 indicates that the claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services. The official description states: ‘Alert: This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services.’ The No Surprises Act is a federal law that aims to protect patients from unexpected medical bills, particularly in situations where they receive care from out-of-network providers.

2. Common Reasons

1. Nonparticipating provider: The air ambulance service was provided by a nonparticipating provider, meaning they do not have a contract with the patient’s insurance plan.
2. No Surprises Act provisions: The claim falls under the regulations and requirements outlined in the No Surprises Act, which includes specific provisions for air ambulance services.
3. Lack of prior authorization: The air ambulance service may not have been pre-authorized by the insurance company, leading to potential coverage issues.
4. Out-of-network coverage: The patient’s insurance plan may not provide adequate coverage for out-of-network air ambulance services, resulting in potential financial responsibility for the patient.

3. Next Steps

1. Review the No Surprises Act provisions: Familiarize yourself with the specific regulations and requirements outlined in the No Surprises Act that apply to air ambulance services provided by nonparticipating providers.
2. Verify prior authorization: Ensure that the air ambulance service was pre-authorized by the insurance company to avoid potential coverage issues.
3. Check out-of-network coverage: Review the patient’s insurance plan to determine the extent of coverage for out-of-network air ambulance services and communicate any potential financial responsibility to the patient.
4. Consider negotiating: If the patient is facing significant financial responsibility due to the use of a nonparticipating air ambulance provider, explore options for negotiating the bill or seeking financial assistance.

4. How To Avoid It

1. Choose participating providers: Whenever possible, opt for air ambulance services provided by participating providers who have contracts with the patient’s insurance plan.
2. Verify coverage: Before utilizing air ambulance services, verify with the insurance company that the specific provider is in-network and covered by the patient’s plan.
3. Obtain prior authorization: Always seek pre-authorization from the insurance company for air ambulance services to ensure coverage.
4. Explore alternative transportation options: In non-emergency situations, consider alternative transportation methods, such as ground ambulances or other forms of medical transport, that may be covered by the insurance plan.

5. Example Cases

1. Case 1: A claim for air ambulance services provided by a nonparticipating provider is subject to the No Surprises Act provisions, resulting in potential financial responsibility for the patient.
2. Case 2: The insurance company denies coverage for air ambulance services due to lack of prior authorization, highlighting the importance of obtaining pre-authorization to avoid claim issues.

Source: Remittance Advice Remark Codes