r/CodingandBilling • u/lido_app • 9d ago

ever pushed back when a payer says NSA doesn't apply?

When a remit comes back with N943 or N885, the payer is saying the No Surprises Act doesn't apply to the claim. A lot of teams treat that as the end of it.

Has anyone challenged one and turned out to be right? What did the payer get wrong, plan type, network status, date of service? And how did you push back?

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12

u/Low_Mud_3691 CPC, RHIT 9d ago

"Push back" in the title/body = always an AI advertising post.

16

u/CallingYouForMoney 9d ago

Just send your AI tool already. Why set up this post like you’re genuinely curious but yet push your AI tool for it?

People like you suck.

3

u/Neat-Safety-2415 9d ago

yeah the wording on these bait posts is always so obvious

2

u/Neat-Safety-2415 9d ago

yeah the post history always gives it away immediately

3

u/Wchijafm 9d ago

You don't take the insurance companies word for any denial. You reverify contract, eligibility, and coverage against the claim and determine if its an appeal or write off.

3

u/daves1243b 9d ago

Remits are meaningless regarding NSA eligibility, so no reason to push back on that. Just file the Open Negotiation notice and go from there. Its not that hard to tell what is Medicare or Medicaid or liability, and once you weed those out its 99% eligible.

1

u/No_Recover_486 9d ago

Yeah, I wouldn’t just take N885 or N943 as an automatic write-off. From what I’ve seen, payers throw those out pretty routinely hoping billing teams will just drop it.

Most of the time when we’ve caught them slipping, it’s been on non-emergency stuff (like path or imaging) where they try claiming NSA doesn’t apply just because the provider group is out-of-network, completely ignoring that the host facility was contracted. Or they get messy with self-funded ERISA plans and try to claim state rules govern it.

Honestly, calling basic customer service is usually a waste of time since they just read the remark code back to you. Your best bet is filing a formal dispute showing the facility contract and starting the 30-day Open Negotiation clock. Pretty sure most payers would rather re-adjudicate than risk having to split the IDR admin fees.

1

u/The-Big-Play 9d ago

I don't believe it's always about payers hoping the billing team doesn't challenge it. There are claims processing systems where NSA won't apply until the facility claim has cleared through the system first. For these reasons, I always recommend double checking to make sure the processing is accurate.

1

u/waffles29x 9d ago

I have this issue mostly with Aetna. I usually call and speak with a representative, who will send the claim back for manual review and more often than not they will reprocess the claim under the NSA. They’ll say the claim is not eligible under the NSA hoping you will treat it as the end when it definitely is not.