Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's Pharmacy plan for further consideration.
Group code
CO, PI or PR
Category
Benefit Maximum/Limitation
Risk level
Medium
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 280 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. |
| N658 | The billed service(s) are not considered medical expenses. |
| N751 | Adjusted because the patient is covered under a Medicare Part D plan. |
| N773 | Drug supplied not obtained from specialty vendor. |
See the full resolution workflow for CARC 280
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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