Skip to main content

N873 Remark Code: Final Payment via All-Payer Model

N873 is an alert that the final out-of-network payment was calculated under an All-Payer Model Agreement, as the No Surprises Act directs when such an agreement applies. The rate comes from the state's model agreement rather than the QPA or arbitration.

Quick facts

Code
N873 (RARC N873)
Status
Active In use since March 1, 2022.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Your charge above the rate set by the All-Payer Model Agreement. It cannot be billed to the patient.
  • PR (Patient Responsibility): Patient cost sharing, generally also calculated from the model agreement amount.
Official description
Alert: This final payment 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
against the official X12 list.

What N873 means

The No Surprises Act ranks the sources a plan uses to set out-of-network payment for protected services. An All-Payer Model Agreement comes first when one applies. That kind of agreement ties the payment of all payers in a state to rates set by the state’s system under an arrangement with CMS.

N873 tells you the plan used that agreement to arrive at a final payment. Because the amount is fixed by the model rather than negotiated, you will not usually see an open negotiation or arbitration step for it.

You are most likely to see N873 on claims for services at facilities in a state operating under such a model.

What to do

  1. Verify the rate. Compare the payment with the rate that applies under the model for your facility and service.
  2. Adjust off the CO amount once it matches.
  3. Charge the patient only the PR amount.
  4. Contact the plan if the payment does not match the model rate, and bring the rate source with you.

Codes that may appear with N873

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): Shows the gap between your charge and the model-agreement rate.
  • PR-1 / PR-2 (Deductible and coinsurance amounts.): The patient's share of the model-agreement rate.
  • N863 (Alert: This claim is subject to the No Surprises Act (NSA).): A similar alert stating the amount paid is the final out-of-network rate under an All Payer Model Agreement.
  • N868 (Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.): Covers the patient's cost sharing under an All-Payer Model Agreement.
  • N872 (Alert: This final payment was calculated based on a specified state law, in accordance with the No Surprises Act.): Final payment set by a specified state law instead.

N873 FAQ

What is an All-Payer Model Agreement?

It is an agreement between a state and CMS under which all payers, including Medicare, pay hospitals and some providers according to rates the state system sets. Maryland's model is the best-known example.

Can I take an N873 payment to federal IDR?

Generally no. When an All-Payer Model Agreement sets the out-of-network rate, that rate is the payment amount and the federal IDR process does not apply to it.

What should I check before posting?

Confirm the paid amount matches the rate the state system publishes or assigns for the service and facility.