Remark Code N599 means that the payment for a service is based upon a reasonable amount according to the terms and conditions of the insurance policy and the Florida No-Fault Statute. This code is used to indicate that the reimbursement for the service is determined by considering various factors such as usual and customary charges, community reimbursement levels, federal and state fee schedules, and other relevant information. The payment for this service is based on 200% of the Participating Level of Medicare Part B fee schedule for the locale where the services were rendered.
1. Description
Remark Code N599 indicates that the payment for a service is determined based on a reasonable amount as per the insurance policy and the Florida No-Fault Statute. The official description states: ‘Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.’
2. Common Reasons
- Usual and customary charges: The reimbursement for the service is based on the usual and customary charges accepted by the provider.
- Community reimbursement levels: Reimbursement levels in the community where the services were rendered are taken into consideration.
- Federal and state fee schedules: Various federal and state fee schedules applicable to automobile and other insurance coverages are considered.
- Other relevant information: Additional information that is relevant to determining the reasonableness of the reimbursement for the service is taken into account.
3. Next Steps
- Review the insurance policy: Understand the terms and conditions of the insurance policy under which the claim is being made.
- Consider usual and customary charges: Ensure that the charges for the service are within the usual and customary range accepted by the provider.
- Be aware of community reimbursement levels: Stay informed about the reimbursement levels in the community where the services were rendered.
- Stay updated on federal and state fee schedules: Keep track of the fee schedules applicable to automobile and other insurance coverages.
- Provide relevant information: Submit any additional information that may be relevant to support the reasonableness of the reimbursement for the service.
4. How To Avoid It
- Understand the insurance policy: Familiarize yourself with the terms and conditions of the insurance policy to ensure compliance.
- Set reasonable charges: Establish charges for services that are within the usual and customary range accepted by the provider.
- Stay informed about reimbursement levels: Keep track of the reimbursement levels in the community where the services are rendered to align with the expected payment.
- Stay updated on fee schedules: Stay informed about the federal and state fee schedules applicable to automobile and other insurance coverages to ensure accurate billing.
- Provide necessary information: Submit all relevant information that supports the reasonableness of the reimbursement for the service.
5. Example Cases
- Case 1: A claim for a medical service is reimbursed based on the usual and customary charges accepted by the provider, demonstrating the importance of setting reasonable charges.
- Case 2: A claim for a service is adjusted according to the community reimbursement levels, highlighting the significance of staying informed about reimbursement levels.
