DENIAL CODES

Denial code N871

Remark code N871 indicates an initial payment calculated as per a specific state law, aligning with the No Surprises Act requirements.

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What is Denial Code N871

Remark code N871 indicates: Alert: This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act.

Common Causes of RARC N871

Common causes of code N871 are:

1. The healthcare provider's billing department incorrectly identified the service location, leading to the application of the wrong state law for the initial payment calculation.

2. The claim was submitted without the necessary documentation to justify the billed amount, resulting in the payer defaulting to the state law specified under the No Surprises Act for initial payment calculation.

3. There was a miscommunication or lack of clarity regarding the patient's coverage plan, causing the payer to apply a state law for the initial payment calculation as a default under the No Surprises Act guidelines.

4. The healthcare provider failed to update their billing system with the latest regulations and rates as per the No Surprises Act, leading to discrepancies in the initial payment calculation.

5. The payer misinterpreted the services provided, applying a state law for the initial payment calculation that does not accurately reflect the nature of the healthcare services rendered.

Ways to Mitigate Denial Code N871

Ways to mitigate code N871 include implementing a robust verification process to ensure that billing practices align with the specific state laws relevant to the No Surprises Act. This involves staying updated on the varying state regulations and how they impact billing and payment calculations. Training billing staff on these laws and their application in billing processes is crucial. Additionally, employing a comprehensive audit system to regularly review payments and billing practices can help identify and correct discrepancies before they result in remark codes. Utilizing technology that automatically updates with the latest regulatory changes can also streamline compliance and prevent this code from occurring.

How to Address Denial Code N871

The steps to address code N871 involve a multi-faceted approach focusing on compliance, billing accuracy, and patient communication. First, ensure that your billing team is fully aware of the specific state law referenced and how it interacts with the No Surprises Act. This may require a brief training session or a review of current billing practices to ensure they align with both state and federal regulations.

Next, conduct a thorough audit of the claim in question to verify that all services billed were accurately coded and that the payment received aligns with the expected amount based on the state law. If discrepancies are found, prepare and submit a detailed appeal to the payer, including any supporting documentation that justifies the correct payment amount.

Additionally, it's crucial to communicate with the patient regarding the status of their claim and any potential impact on their bill. Provide clear, understandable information about how the state law affects their payment responsibility and reassure them that your team is working to resolve any issues with their insurance company.

Finally, document all steps taken to address code N871, including internal reviews, communications with the payer, and patient interactions. This documentation will be invaluable for future reference and can help streamline the process if similar issues arise again.

CARCs Associated to RARC N871

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