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N855 Remark Code: Coverage Governed by ERISA

N855 means the patient's coverage is subject to the exclusive jurisdiction of ERISA, the federal Employee Retirement Income Security Act of 1974. It tells providers that federal ERISA rules, rather than state insurance law, generally govern the plan, including its claims and appeal procedures.

Quick facts

Code
N855 (RARC N855)
Status
Active In use since July 1, 2021.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any CO adjustment on the claim is explained by its CARC; N855 describes the legal framework, not the amount.
  • PR (Patient Responsibility): Patient responsibility is set by the plan's terms under ERISA.
Official description
This coverage is subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N855 means

ERISA is the federal law that governs most private employer-sponsored benefit plans. When a plan falls under ERISA’s exclusive jurisdiction, federal rules control how claims and appeals are handled, and many state insurance laws are preempted, especially for self-funded plans.

N855 is the payer telling you this claim’s coverage falls in that category. The remark doesn’t change payment by itself. It shapes what happens next: which appeal rights apply, which laws you can rely on, and where disputes are decided.

Why it matters

  • Appeals follow ERISA procedures. The plan must provide a full and fair review, and there are set timeframes. Many plans require an assignment or authorized representative designation for a provider to appeal.
  • State mandates may not apply. Self-funded ERISA plans generally aren’t bound by state coverage mandates, prompt pay laws, or state balance billing laws.
  • Federal protections still apply where federal law covers the plan, such as the No Surprises Act.

What to do

  1. Read the CARCs to see how the claim was actually adjudicated.
  2. If you’ll appeal, follow the plan’s ERISA appeal procedure and timeframes, and get the member’s authorization if the plan requires it.
  3. Don’t rely on state insurance law in appeals without confirming it applies to this plan type.
  4. Request plan documents such as the summary plan description if you need the plan’s exact terms, typically through the member.

For legal questions about preemption or litigation, consult counsel. The remittance only signals which framework applies.

Codes that may appear with N855

  • CO-96 (Non-covered charge(s).): A non-covered charge under the plan's terms.
  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service isn't covered under the patient's current benefit plan.
  • N856 (This coverage is not subject to the exclusive jurisdiction of ERISA (1974), U.S.C.): The opposite notice: the coverage is not subject to ERISA's exclusive jurisdiction.
  • N830 (Alert: The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations.): Federal or state balance billing protections were applied to the claim.

N855 FAQ

Which plans are ERISA plans?

Most private employer-sponsored health plans are governed by ERISA. Government plans and church plans are generally exempt. Self-funded employer plans are especially important because they are largely outside state insurance regulation.

How does ERISA affect appeals?

ERISA plans must follow federal claims and appeal procedures, and the member must usually complete them before going to court. Providers often appeal with the member's authorization.

Do state prompt pay or balance billing laws apply?

Often not to self-funded ERISA plans, because of federal preemption. Federal protections, such as the No Surprises Act, may still apply. Get legal advice for specific questions.