Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
Group code
CO, PI or PR
Category
Coordination of Benefits
Risk level
High
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 109 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M11 | DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code. |
| M114 | This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor. |
| N36 | Claim must meet primary payer's processing requirements before we can consider payment. |
| N104 | This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov. |
| N105 | This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI information for electronic claims processing. |
| N106 | Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service. |
| N127 | This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them. |
| N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. |
See the full resolution workflow for CARC 109
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every CARC and RARC pairing, plus payer-specific quirks.
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