DENIAL CODES

Denial code N864

Remark code N864 is an alert indicating the claim falls under the No Surprises Act for emergency services.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is Denial Code N864

Remark code N864 indicates: Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.

Common Causes of RARC N864

Common causes of code N864 (Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services) are incorrect billing for services that fall under the emergency service category, failure to identify or apply the No Surprises Act provisions accurately, or misclassification of the service type which should be recognized as emergency services according to the No Surprises Act guidelines.

Ways to Mitigate Denial Code N864

Ways to mitigate code N864 include ensuring that your billing team is thoroughly trained on the No Surprises Act provisions, specifically regarding emergency services. Implement a system to identify and flag services that fall under the No Surprises Act to ensure they are billed correctly. Regularly review and update your billing practices to align with the latest regulations and guidelines. Additionally, establish a clear communication channel with patients about the costs of emergency services and their rights under the No Surprises Act to prevent misunderstandings and disputes. Engage in proactive audits of claims related to emergency services to catch and correct any issues before they result in denials or delays.

How to Address Denial Code N864

The steps to address code N864 involve a multi-faceted approach to ensure compliance with the No Surprises Act provisions for emergency services. First, review the claim to confirm that the services billed align with the emergency services as defined under the Act. Next, verify that the patient's insurance information is accurate and up-to-date to prevent any billing discrepancies. It's crucial to check that the billing rates applied are in accordance with the guidelines set forth by the No Surprises Act, focusing on the out-of-network care provisions if applicable.

Subsequently, communicate with the patient to inform them of their protections under the No Surprises Act, including any potential out-of-pocket costs they may face. This step is essential for maintaining transparency and trust with the patient. If the claim has been denied or requires modification, promptly adjust the billing codes or services charged as necessary and resubmit the claim with detailed documentation supporting the emergency nature of the services provided.

Lastly, ensure that your billing team is well-versed in the No Surprises Act provisions and regularly update your billing practices to stay compliant with any changes in the legislation. This proactive approach will help minimize future occurrences of code N864 and streamline the claims process for emergency services under the No Surprises Act.

CARCs Associated to RARC N864

Improve your financial performance while providing a more transparent patient experience

Full Page Background