Skip to main content

N867 Remark Code: NSA Cost Share Set by State Law

N867 is an alert that the patient's cost sharing was calculated using a specified state law, as the No Surprises Act allows. Where a state surprise billing law sets the amount for the service and plan, it takes the place of the federal QPA-based calculation.

Quick facts

Code
N867 (RARC N867)
Status
Active In use since March 1, 2022.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The patient's share was calculated under the state law and is the most they owe.
Official description
Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N867 means

The No Surprises Act doesn’t override every state surprise billing law. For plans a state regulates, if the state has a law that determines payment for a service the Act protects, that specified state law generally sets both the out-of-network amount and the base for patient cost sharing. N867 tells you that path was used for the patient’s share on this claim.

The practical effect is the same for the patient: in-network-level cost sharing and no balance billing. The difference is in which rules and numbers the plan used.

What to do

  1. Bill the patient only the PR amount reported.
  2. Identify the state law involved so you know which dispute process applies.
  3. Review payment under that law’s terms, not the federal QPA rules.
  4. Use the state’s dispute route if you disagree with the payment, following its deadlines.

Codes that may appear with N867

  • PR-2 (Coinsurance Amount): Coinsurance calculated using the state law's amount.
  • PR-1 (Deductible Amount): Deductible amount calculated the same way.
  • N868 (Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.): Cost sharing was based on an All-Payer Model Agreement instead of a state law.
  • N871 (Alert: This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act.): The plan's initial payment, not the cost share, was based on a specified state law.
  • N860 (Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).): Cost sharing was based on the federal QPA.

N867 FAQ

What is a specified state law?

Under the No Surprises Act, it's a state law that provides a method for determining the total payment for an out-of-network service covered by the federal protections, for plans the state regulates.

How is this different from N860 or N862?

Those codes mean the federal QPA-based rule set cost sharing. N867 means a state law set it, which happens only when a state law applies to that plan and service.

Where do disputes go?

When a specified state law sets the payment, disputes typically follow the state's process rather than federal IDR. Check the state's rules.