Plan procedures not followed.
Group code
CO, PI or PR
Category
Plan Provision
Risk level
Medium
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 95 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N33 | No record of health check prior to initiation of treatment. |
| N79 | Service billed is not compatible with patient location information. |
| N182 | This claim/service must be billed according to the schedule for this plan. |
| N385 | Notification of admission was not timely according to published plan procedures. |
| N584 | Not covered based on the insured's noncompliance with policy or statutory conditions. |
| N593 | Not covered based on failure to attend a scheduled Independent Medical Exam (IME). |
| N594 | Records reflect the injured party did not complete an Application for Benefits for this loss. |
| N595 | Records reflect the injured party did not complete an Assignment of Benefits for this loss. |
See the full resolution workflow for CARC 95
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