Remark Code N875 means that the final payment for a claim equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity (FIDRE) in accordance with the No Surprises Act. This code serves as an alert to healthcare providers and insurance companies regarding the payment determination for out-of-network services.
1. Description
Remark Code N875 indicates that the final payment for a claim has been determined based on the out-of-network rate selected by a Federal Independent Dispute Resolution Entity (FIDRE) in accordance with the No Surprises Act. The official description states: ‘Alert: This final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act.’ This code is designed to inform healthcare providers and insurance companies about the payment decision for out-of-network services.
2. Common Reasons
- Out-of-network services: The claim may involve services provided by healthcare professionals or facilities that are not within the patient’s insurance network.
- No Surprises Act: The No Surprises Act is a federal law that protects patients from unexpected medical bills for out-of-network services. The FIDRE determines the final payment based on the out-of-network rate specified in the Act.
- Dispute resolution process: The FIDRE reviews the claim and makes a determination regarding the appropriate payment for out-of-network services, ensuring a fair resolution for both the healthcare provider and the insurance company.
3. Next Steps
- Review the payment determination: Healthcare providers should carefully review the payment determination to ensure it aligns with the out-of-network rate specified by the FIDRE.
- Verify the accuracy of the claim: Double-check the claim details to ensure all services and charges are accurately reflected.
- Contact the insurance company: If there are any discrepancies or concerns regarding the payment determination, healthcare providers can reach out to the insurance company for clarification or further information.
4. How To Avoid It
- Stay in-network whenever possible: Encourage patients to seek healthcare services from providers and facilities within their insurance network to minimize the likelihood of out-of-network claims.
- Verify insurance coverage: Before providing services, verify the patient’s insurance coverage and ensure that the services will be covered by their plan.
- Communicate with patients: Clearly communicate any potential out-of-network charges to patients, providing them with an opportunity to make informed decisions about their healthcare.
5. Example Cases
- Case 1: A healthcare provider submits a claim for out-of-network services, and the final payment is determined based on the out-of-network rate specified by the FIDRE, in accordance with the No Surprises Act.
- Case 2: An insurance company receives a claim for out-of-network services and processes the payment according to the out-of-network rate selected by the FIDRE, ensuring compliance with the No Surprises Act.
