'New Patient' qualifications were not met.
Group code
CO, PI or PR
Category
Billing
Risk level
High
Appealable
Yes
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC B16 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M13 | Only one initial visit is covered per specialty per medical group. |
| M86 | Service denied because payment already made for same/similar procedure within set time frame. |
| N113 | Only one initial visit is covered per physician, group practice or provider. |
See the full resolution workflow for CARC B16
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