Services not authorized by network/primary care providers.
Group code
CO, PI or PR
Category
Referral/Network
Risk level
Medium
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 243 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M115 | This item is denied when provided to this patient by a non-contract or non-demonstration supplier. |
| N95 | This provider type/provider specialty may not bill this service. |
| N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. |
| N450 | Covered only when performed by the primary treating physician or the designee. |
| N630 | Referral not authorized by attending physician). |
| N767 | The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed. |
See the full resolution workflow for CARC 243
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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