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N885 Remark Code: Payer Says NSA Does Not Apply

N885 is an alert that the payer did not apply No Surprises Act cost-sharing or out-of-network payment rules because it disagrees with your view that they apply. You can ask the payer why and appeal on the patient's behalf through its internal appeal and external review processes.

Quick facts

Code
N885 (RARC N885)
Status
Active In use since November 1, 2022.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Cost sharing calculated under the plan's normal out-of-network terms, which may be higher than the Act would allow if it applied.
  • CO (Contractual Obligation): Amounts the plan did not allow under its standard processing.
Official description
Alert: This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those requirements apply. You may contact the payer to find out why it disagrees. You may appeal this adverse determination on behalf of the patient through the payer’s internal appeals and external review processes.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N885 means

Your claim told the payer the No Surprises Act applied, for example through claim indicators or the facts of the service. The payer reviewed it and disagreed. As a result, it processed the claim like standard out-of-network care, which can mean higher patient cost sharing and a lower plan payment.

N885 also gives you a road map: ask the payer why, and use its internal appeal and external review processes on the patient’s behalf.

Common causes

  • The plan does not consider the visit an emergency.
  • The facility was not participating with the plan on the date of service.
  • The service falls outside the Act’s scope, such as a plan type the Act does not cover.
  • The plan believes the patient waived protections through consent.

What to do

  1. Request the reason from the payer in writing.
  2. Get the patient’s authorization to appeal on their behalf.
  3. Assemble evidence: emergency records, facility participation, and claim details showing the Act applies.
  4. File the internal appeal, and request external review if the plan upholds its decision.
  5. Hold the patient balance at in-network-level cost sharing while the appeal is pending if you believe the Act applies.

See how to read CARC and RARC codes for pairing remarks with reason codes.

Codes that may appear with N885

  • CO-242 (Services not provided by network/primary care providers.): Services not provided by network or primary care providers, a common basis when the plan treats the claim as ordinary out-of-network care.
  • PR-1 / PR-2 (Deductible and coinsurance amounts.): Out-of-network cost sharing the plan applied because it did not use the Act.
  • N884 (Alert: The No Surprises Act may apply to this claim.): The payer is still deciding whether the Act applies and needs facility information.
  • N864 (Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.): The Act's emergency services rules were applied.
  • N865 (Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a…): The Act's rules for non-emergency care at participating facilities were applied.

N885 FAQ

Why would a payer say the Act does not apply?

Common reasons include treating the service as non-emergency, finding the facility was not in-network, deciding the plan type is not covered by the Act, or concluding a valid consent waived protections. Ask the payer for its specific reason.

Who can appeal?

The remark says you may appeal on behalf of the patient, which usually requires the patient's written authorization as the plan specifies.

Can I use federal IDR instead?

Federal IDR is for payment disputes on claims the Act covers. When the plan disputes coverage under the Act itself, the internal appeal and external review route is the one the remark describes.