How To Fix Remark Code M697 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N492 means that a network provider may bill the member for a service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge. This code serves as an alert to both healthcare providers and insurance companies, indicating that the member has agreed to bear the financial responsibility for the specific service.

1. Description

Remark Code N492 is an alert code that signifies a specific scenario where a network provider may bill the member for a service. The official description states: ‘A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge.’ This code was implemented on July 1, 2008, to ensure transparency and clarity regarding financial responsibility between the member and the network provider.

2. Common Reasons

1. Member requested the service: The member actively sought out the specific service from the network provider.
2. Member agreed in writing to be financially responsible: Prior to receiving the service, the member provided written consent, acknowledging their responsibility for the billed charge.

3. Next Steps

1. Review the member’s written agreement: Verify that the member indeed agreed in writing to be financially responsible for the service.
2. Communicate with the member: If there are any discrepancies or concerns, reach out to the member to address the situation and clarify any misunderstandings.
3. Ensure accurate billing: Make sure that the billed charge aligns with the agreed-upon amount and that it is appropriately documented.

4. How To Avoid It

1. Obtain written consent: Prior to providing the service, ensure that the member provides written consent, clearly stating their agreement to be financially responsible for the billed charge.
2. Communicate the financial responsibility: Clearly explain to the member the potential financial implications of requesting the specific service and obtaining their agreement in writing.
3. Document the agreement: Keep a copy of the member’s written agreement on file for future reference and billing purposes.

5. Example Cases

1. Case 1: A member requests a specialized cosmetic procedure and signs a written agreement acknowledging their responsibility for the billed charge. The network provider bills the member accordingly, citing Remark Code N492.
2. Case 2: A member undergoes an elective surgery and provides written consent, agreeing to be financially responsible for any additional charges not covered by insurance. The network provider bills the member for the uncovered expenses, utilizing Remark Code N492.

Source: Remittance Advice Remark Codes