Remark code N856 is an explanation that the coverage does not fall under ERISA (1974) jurisdiction, as per U.S.C. SEC 1001.
Remark code N856 indicates that the insurance coverage in question is not governed exclusively by the Employee Retirement Income Security Act (ERISA) of 1974, as outlined in the United States Code (U.S.C.) Section 1001.
Common causes of code N856 are:
1. The insurance plan is identified as a government or church plan, which is exempt from ERISA.
2. Incorrect plan information was submitted, leading to misclassification as an ERISA plan.
3. The claim was submitted for a service or provider type that ERISA does not cover.
4. Documentation provided does not sufficiently prove the plan's ERISA status.
5. The payer has updated or changed their criteria for ERISA jurisdiction, and the plan no longer qualifies under the new guidelines.
Ways to mitigate code N856 include ensuring that the billing team is well-versed in identifying the types of insurance plans that are not governed by ERISA (Employee Retirement Income Security Act of 1974) regulations. This involves training staff to recognize government-managed plans, church plans, and other non-ERISA entities during the patient registration process. Implementing a robust verification process that includes checking the plan's jurisdiction and coverage specifics before submitting claims can prevent this code from appearing. Additionally, setting up a pre-authorization and eligibility verification system that flags potential non-ERISA plans can help in taking the necessary steps before providing services. Regular audits of billing practices related to ERISA and non-ERISA plans can also ensure compliance and reduce the occurrence of this code.
The steps to address code N856 involve a multi-faceted approach to ensure proper handling and billing procedures. Initially, verify the patient's coverage details and benefits by directly contacting the insurance provider. This verification process should aim to clarify the specific exclusions or limitations of the patient's policy that led to the remark code. Following this, review the patient's account to identify any alternative insurance information that may be applicable and subject to ERISA regulations. If alternative coverage is not available, consider the possibility of billing the patient directly for the services rendered, ensuring to communicate clearly the reasons for direct billing and providing a detailed breakdown of the charges. Additionally, it's crucial to document all communications and findings thoroughly in the patient's account for future reference and to support any potential appeals or disputes. Lastly, educate the billing and coding team on this specific remark code to prevent future occurrences, emphasizing the importance of accurate insurance verification and documentation practices.
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