An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).
Group code
CO or PI
Category
Documentation
Risk level
High
Appealable
Yes
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 252 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M19 | Missing oxygen certification/re-certification. |
| M21 | Missing/incomplete/invalid place of residence for this service/item provided in a home. |
| M23 | Missing invoice. |
| M29 | Missing operative note/report. |
| M30 | Missing pathology report. |
| M31 | Missing radiology report. |
| M42 | The medical necessity form must be personally signed by the attending physician. |
| M60 | Missing Certificate of Medical Necessity. |
See the full resolution workflow for CARC 252
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 requirements.
Open in EDI Lab