The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Group code
CO, PI or PR
Category
Credentialing/Enrollment
Risk level
High
Appealable
Yes
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 185 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N95 | This provider type/provider specialty may not bill this service. |
| N386 | This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy. |
| N448 | This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement. |
| N450 | Covered only when performed by the primary treating physician or the designee. |
| N570 | Missing/incomplete/invalid credentialing data. |
| N684 | Payment denied as this is a specialty claim submitted as a general claim. |
| N767 | The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed. |
| N790 | Provider/supplier not accredited for product/service. |
See the full resolution workflow for CARC 185
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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