Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC P21 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M80 | Not covered when performed during the same session/date as a previously processed service for the patient. |
| MA04 | Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible. |
| N10 | Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review. |
| N36 | Claim must meet primary payer's processing requirements before we can consider payment. |
| N95 | This provider type/provider specialty may not bill this service. |
| N158 | Transportation in a vehicle other than an ambulance is not covered. |
| N409 | This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident. |
| N479 | Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer). |
See the full resolution workflow for CARC P21
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