DENIAL CODES

Denial code N874

Remark code N874 is an alert indicating the final payment was set via open negotiation under the No Surprises Act.

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What is Denial Code N874

Remark code N874 indicates: Alert: This final payment was determined through open negotiation, in accordance with the No Surprises Act.

Common Causes of RARC N874

Common causes of code N874 are discrepancies or disagreements between the healthcare provider and the insurance payer regarding the billed amount for out-of-network services, leading to a negotiated settlement as mandated by the No Surprises Act. This may involve situations where the initial billed amount was significantly higher than what the payer deemed reasonable, or where there was a lack of clarity about the provider's network status, necessitating a negotiation to arrive at a final payment amount.

Ways to Mitigate Denial Code N874

Ways to mitigate code N874 include implementing a robust verification process to ensure accurate patient insurance information is collected and verified before services are rendered. Training staff on the specifics of the No Surprises Act and how it impacts billing and negotiations can also be beneficial. Establishing clear communication channels with insurance providers to discuss and agree upon payment rates before delivering services can prevent misunderstandings. Additionally, adopting advanced billing software that is updated with the latest regulatory changes, including those related to the No Surprises Act, can help in accurately predicting and negotiating payments, thus avoiding this remark code. Regular audits of billing and negotiation processes can also identify potential issues early, allowing for corrective action to be taken before they result in code N874.

How to Address Denial Code N874

The steps to address code N874 involve a multi-faceted approach focusing on ensuring compliance and optimizing future negotiations under the No Surprises Act. Firstly, it's crucial to document the negotiation process meticulously, including all communication and the final agreed-upon payment. This documentation will serve as a reference for future disputes or audits and help in understanding the negotiation dynamics for similar cases.

Secondly, analyze the negotiation outcome to identify any patterns or areas for improvement. This could involve assessing if the negotiated amount aligns with the cost of services provided and identifying any recurrent issues that may be affecting payment outcomes. Based on this analysis, develop a strategy for future negotiations to secure more favorable terms. This might include training for staff involved in negotiations to enhance their skills and understanding of the No Surprises Act.

Additionally, update your billing and coding practices to reflect insights gained from the negotiation process. This could involve adjusting how services are coded or improving the accuracy of initial claims to minimize the need for negotiations. It's also beneficial to engage with payer representatives to discuss the outcome and explore opportunities for streamlining the payment process for future claims.

Lastly, consider leveraging technology solutions that can aid in managing negotiations and compliance with the No Surprises Act. This could include software that tracks negotiation outcomes, automates documentation, and provides analytics to guide future negotiations. By adopting a comprehensive approach that includes documentation, analysis, strategy development, practice improvement, payer engagement, and technology utilization, healthcare providers can effectively address code N874 and enhance their negotiation outcomes under the No Surprises Act.

CARCs Associated to RARC N874

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