How To Fix Remark Code M1065 (RARC) | Common Reasons, Next Steps & How To Avoid It
Remark Code N870 means that cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount, in accordance with the No Surprises Act. This code is used to alert healthcare providers and insurance companies about the billing and payment process related to the No Surprises Act.
1. Description
Remark Code N870 indicates that cost sharing was calculated based on the billed amount because the billed amount was lower than the qualifying payment amount. This is in accordance with the No Surprises Act, which aims to protect patients from unexpected medical bills. The official description states: ‘Alert: In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount.’
2. Common Reasons
- Billed amount lower than the qualifying payment amount: This can occur when the healthcare provider charges a lower amount for the service than what is considered the qualifying payment amount.
3. Next Steps
- Review the billing and payment process: Ensure that the billing and payment process complies with the No Surprises Act and accurately reflects the billed amount.
- Verify the qualifying payment amount: Confirm that the qualifying payment amount is correctly calculated and applied to the cost sharing.
4. How To Avoid It
- Stay informed about the No Surprises Act: Familiarize yourself with the provisions of the No Surprises Act to ensure compliance with billing and payment requirements.
- Accurately calculate and document the billed amount: Ensure that the billed amount accurately reflects the services provided and is in line with the qualifying payment amount.
5. Example Cases
- Case 1: A patient receives a medical service with a billed amount lower than the qualifying payment amount. As a result, the cost sharing is based on the billed amount in accordance with the No Surprises Act.
Source: Remittance Advice Remark Codes
