Denial code N873

Remark code N873 is an alert indicating final payment was based on an All-Payer Model Agreement under the No Surprises Act.

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What is Denial Code N873

Remark code N873 is an alert indicating that the final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.

Common Causes of RARC N873

Common causes of code N873 are:

1. The healthcare provider's billing system may not have been updated to reflect the latest All-Payer Model Agreement terms, leading to discrepancies in the billed amount versus the expected payment under the agreement.

2. Incorrect patient information or insurance details were provided, causing the claim to be processed under the wrong terms or payer agreement.

3. The services rendered were not covered under the specific terms of the All-Payer Model Agreement applicable to the patient's insurance plan, leading to adjustments in the final payment.

4. There was a lack of proper documentation or coding errors in the claim submission, which affected the calculation of the final payment according to the No Surprises Act guidelines.

5. The claim was submitted after the deadline specified in the All-Payer Model Agreement, resulting in adjustments or reductions in the final payment amount.

Ways to Mitigate Denial Code N873

Ways to mitigate code N873 include implementing a robust verification system to ensure that all charges are aligned with the All-Payer Model Agreement terms before submission. Regular training for billing staff on the latest updates of the No Surprises Act and its implications on billing practices is crucial. Additionally, establishing a clear communication channel with payers to resolve any discrepancies in real-time can prevent this code. Utilizing advanced billing software that automatically updates and applies the latest billing regulations can also help in avoiding such issues. Regular audits of billing processes and compliance checks can further ensure adherence to the No Surprises Act, minimizing the risk of receiving code N873.

How to Address Denial Code N873

The steps to address code N873 involve a multi-faceted approach focusing on understanding the specifics of the All-Payer Model Agreement and ensuring compliance with the No Surprises Act. Initially, it's crucial to review the payment details against the contracted rates agreed upon under the All-Payer Model Agreement. This involves verifying the services provided, the rates applied, and ensuring that the final payment aligns with the expected amount based on the agreement.

Next, audit your billing and coding practices to ensure that they are in strict compliance with the No Surprises Act, focusing on transparency and patient protection against unexpected medical bills. This may involve training or re-training staff on the specifics of the Act and how it impacts billing practices.

If discrepancies are found in the payment amount, prepare and submit a detailed appeal to the payer, including documentation that supports the expected payment amount under the All-Payer Model Agreement. This documentation could include the original contract, a breakdown of services provided, and the applicable rates.

Additionally, it's advisable to engage in direct communication with the payer to discuss the specifics of the payment calculation under the All-Payer Model Agreement. This can help clarify any misunderstandings and expedite the resolution of discrepancies.

Finally, consider implementing a system for regularly reviewing payments received under All-Payer Model Agreements to quickly identify and address any issues related to the No Surprises Act compliance. This proactive approach can help minimize future occurrences of code N873 and ensure that payments are received as expected.

CARCs Associated to RARC N873

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