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N863 Remark Code: Final NSA Rate From All-Payer Model

N863 is an alert that the claim is subject to the No Surprises Act and that the amount paid is the final out-of-network rate, calculated under an All-Payer Model Agreement. Where such an agreement applies, it sets the payment, so the federal negotiation and IDR process generally doesn't apply.

Quick facts

Code
N863 (RARC N863)
Status
Active In use since March 1, 2022.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Patient cost sharing follows the Act and is the only amount the patient owes.
  • CO (Contractual Obligation): The difference between the charge and the final rate can't be balance billed to the patient.
Official description
Alert: This claim is subject to the No Surprises Act (NSA). The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N863 means

The No Surprises Act uses a hierarchy to set the out-of-network rate for protected services. If an All-Payer Model Agreement applies, it comes first. If not, a specified state law applies. If neither applies, the rate comes from negotiation or federal IDR. N863 tells you the first tier applied: an All-Payer Model Agreement set the rate, and the amount paid is final.

That matters most for disputes. With the rate fixed by the agreement, the federal open negotiation and IDR path isn’t generally available.

What to do

  1. Post the payment as final and the reduction as a provider adjustment.
  2. Limit patient billing to the PR amounts.
  3. Check the calculation against the rate that should apply under the agreement, and contact the plan if it looks wrong.
  4. Don’t start federal IDR for this claim without confirming it’s eligible.

Codes that may appear with N863

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge was reduced to the rate set under the All-Payer Model Agreement.
  • N868 (Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.): The patient's cost sharing, rather than the payment, was based on an All-Payer Model Agreement.
  • N873 (Alert: This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.): Another alert that a final payment was calculated under an All-Payer Model Agreement.
  • N859 (Alert: The Federal No Surprise Billing Act was applied to the processing of this claim.): The general alert that the No Surprises Act was applied.

N863 FAQ

What is an All-Payer Model Agreement?

It's an agreement between a state and CMS under which payers in the state pay according to a common rate-setting system. Maryland's all-payer system is the best-known example.

Can I use federal IDR to dispute an N863 payment?

Generally not, because the All-Payer Model Agreement determines the out-of-network rate. If you think the rate was calculated wrong, raise it with the plan.

Can I bill the patient more?

No. Patient cost sharing under the Act is limited to what the plan reported.