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N868 Remark Code: NSA Cost Share From All-Payer Model

N868 is an alert that the patient's cost sharing was calculated under an All-Payer Model Agreement, in line with the No Surprises Act. When such an agreement applies in the state, it sets the base for cost sharing ahead of any state law or the federal QPA.

Code: N868 (RARC N868)
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 from the All-Payer Model rate and is all they owe for the service.
Official description: Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N868 means

The No Surprises Act uses a set order to decide the amount patient cost sharing is based on: an applicable All-Payer Model Agreement first, then a specified state law, then the lesser of the QPA or billed charge. N868 tells you the first option applied. The patient’s deductible, copay, or coinsurance on this claim was calculated from the rate set under an All-Payer Model Agreement.

This is uncommon outside states with such agreements, so N868 mostly appears on claims connected to those states.

What to do

Bill the patient only the PR amount and refund anything collected above it.
Check the payment remarks. If N863 or N873 appears, the agreement also set the final payment.
Confirm the calculation with the plan if the cost share looks inconsistent with the agreement’s rates.
Don’t assume federal IDR applies when the agreement determines the rate.

Codes that may appear with N868

PR-2 (Coinsurance Amount): Coinsurance calculated from the All-Payer Model rate.
PR-1 (Deductible Amount): Deductible amount calculated from the same base.

N863 (Alert: This claim is subject to the No Surprises Act (NSA).): The plan's final payment, not just the cost share, was set by an All-Payer Model Agreement.
N867 (Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.): Cost sharing was based on a specified state law instead.
N869 (Alert: Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act.): Cost sharing was based on the QPA instead.

N868 FAQ

Where do All-Payer Model Agreements apply?

In states that have such an agreement with CMS. Maryland's all-payer system is the best-known example. Most states don't have one.

Does N868 change what I can bill the patient?

No. As with other No Surprises Act protections, you can bill only the PR amount.

Is the payment also set by the agreement?

Usually, if the agreement applies to the service, the out-of-network rate follows it too. Look for N863 or N873 on the claim.

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