Alternate benefit has been provided.
Group code
CO, PI or PR
Category
Plan Provision
Risk level
High
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 169 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| MA109 | Claim processed in accordance with ambulatory surgical guidelines. |
| N10 | Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review. |
See the full resolution workflow for CARC 169
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.
Open in EDI Lab