Every CARC and RARC code, indexed.

This is the complete list of the 298 claim adjustment reason codes and 1,138 remittance advice remark codes in use today, 1,436 pages in all. Every code links to its own page with the official X12 description, the group code that tells you who is financially responsible, the denial category, the risk level, and whether the denial is appealable or requires a correction.

The resolution paths, root cause analysis, prevention steps and appeal language are in the EDI Code Intelligence Lab and are not published here.

Code set last updated September 10, 2026

Claim adjustment reason codes

A CARC states the high-level reason a line or claim was adjusted. It is the code you work first.

Numeric codes · 246

CARC 1 Deductible Amount
CARC 2 Coinsurance Amount
CARC 3 Co-payment Amount
CARC 4 The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 5 The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 6 The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 7 The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 8 The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 9 The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 10 The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 11 The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 12 The diagnosis is inconsistent with the provider type. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 13 The date of death precedes the date of service.
CARC 14 The date of birth follows the date of service.
CARC 15Deactivated The authorization number is missing, invalid, or does not apply to the billed services or provider.
CARC 16 Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. 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.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 18 Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)
CARC 19 This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
CARC 20 This injury/illness is covered by the liability carrier.
CARC 21 This injury/illness is the liability of the no-fault carrier.
CARC 22 This care may be covered by another payer per coordination of benefits.
CARC 23 The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)
CARC 24 Charges are covered under a capitation agreement/managed care plan.
CARC 26 Expenses incurred prior to coverage.
CARC 27 Expenses incurred after coverage terminated.
CARC 29 The time limit for filing has expired.
CARC 31 Patient cannot be identified as our insured.
CARC 32 Our records indicate the patient is not an eligible dependent.
CARC 33 Insured has no dependent coverage.
CARC 34 Insured has no coverage for newborns.
CARC 35 Lifetime benefit maximum has been reached.
CARC 39 Services denied at the time authorization/pre-certification was requested.
CARC 40 Charges do not meet qualifications for emergent/urgent care. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 44 Prompt-pay discount.
CARC 45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)
CARC 49 This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 51 These are non-covered services because this is a pre-existing condition. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 53 Services by an immediate relative or a member of the same household are not covered.
CARC 54 Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 55 Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 56 Procedure/treatment has not been deemed 'proven to be effective' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.
CARC 61 Adjusted for failure to obtain second surgical opinion.
CARC 66 Blood Deductible.
CARC 69 Day outlier amount.
CARC 70 Cost outlier - Adjustment to compensate for additional costs.
CARC 74 Indirect Medical Education Adjustment.
CARC 75 Direct Medical Education Adjustment.
CARC 76 Disproportionate Share Adjustment.
CARC 78 Non-Covered days/Room charge adjustment.
CARC 85 Patient Interest Adjustment (Use Only Group code PR)
CARC 89 Professional fees removed from charges.
CARC 90 Ingredient cost adjustment. Usage: To be used for pharmaceuticals only.
CARC 91 Dispensing fee adjustment.
CARC 94 Processed in Excess of charges.
CARC 95 Plan procedures not followed.
CARC 96 Non-covered charge(s). 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.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 100 Payment made to patient/insured/responsible party.
CARC 101 Predetermination: anticipated payment upon completion of services or claim adjudication.
CARC 102 Major Medical Adjustment.
CARC 103 Provider promotional discount (e.g., Senior citizen discount).
CARC 104 Managed care withholding.
CARC 105 Tax withholding.
CARC 106 Patient payment option/election not in effect.
CARC 107 The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 108 Rent/purchase guidelines were not met. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 109 Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
CARC 110 Billing date predates service date.
CARC 111 Not covered unless the provider accepts assignment.
CARC 112 Service not furnished directly to the patient and/or not documented.
CARC 114 Procedure/product not approved by the Food and Drug Administration.
CARC 115 Procedure postponed, canceled, or delayed.
CARC 116 The advance indemnification notice signed by the patient did not comply with requirements.
CARC 117 Transportation is only covered to the closest facility that can provide the necessary care.
CARC 118 ESRD network support adjustment.
CARC 119 Benefit maximum for this time period or occurrence has been reached.
CARC 121 Indemnification adjustment - compensation for outstanding member responsibility.
CARC 122 Psychiatric reduction.
CARC 128 Newborn's services are covered in the mother's Allowance.
CARC 129 Prior processing information appears incorrect. 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.)
CARC 130 Claim submission fee.
CARC 131 Claim specific negotiated discount.
CARC 132 Prearranged demonstration project adjustment.
CARC 133 The disposition of this service line is pending further review. (Use only with Group Code OA). Usage: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837).
CARC 134 Technical fees removed from charges.
CARC 135 Interim bills cannot be processed.
CARC 136 Failure to follow prior payer's coverage rules. (Use only with Group Code OA)
CARC 137 Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
CARC 139 Contracted funding agreement - Subscriber is employed by the provider of services. Use only with Group Code CO.
CARC 140 Patient/Insured health identification number and name do not match.
CARC 142 Monthly Medicaid patient liability amount.
CARC 143 Portion of payment deferred.
CARC 144 Incentive adjustment, e.g. preferred product/service.
CARC 146 Diagnosis was invalid for the date(s) of service reported.
CARC 147 Provider contracted/negotiated rate expired or not on file.
CARC 148 Information from another provider was not provided or was insufficient/incomplete. 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.)
CARC 149 Lifetime benefit maximum has been reached for this service/benefit category.
CARC 150 Payer deems the information submitted does not support this level of service.
CARC 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
CARC 152 Payer deems the information submitted does not support this length of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 153 Payer deems the information submitted does not support this dosage.
CARC 154 Payer deems the information submitted does not support this day's supply.
CARC 155 Patient refused the service/procedure.
CARC 157 Service/procedure was provided as a result of an act of war.
CARC 158 Service/procedure was provided outside of the United States.
CARC 159 Service/procedure was provided as a result of terrorism.
CARC 160 Injury/illness was the result of an activity that is a benefit exclusion.
CARC 161 Provider performance bonus
CARC 163 Attachment/other documentation referenced on the claim was not received.
CARC 164 Attachment/other documentation referenced on the claim was not received in a timely fashion.
CARC 166 These services were submitted after this payers responsibility for processing claims under this plan ended.
CARC 167 This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 169 Alternate benefit has been provided.
CARC 170 Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 171 Payment is denied when performed/billed by this type of provider in this type of facility. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 172 Payment is adjusted when performed/billed by a provider of this specialty. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 173 Service/equipment was not prescribed by a physician.
CARC 174 Service was not prescribed prior to delivery.
CARC 175 Prescription is incomplete.
CARC 176 Prescription is not current.
CARC 177 Patient has not met the required eligibility requirements.
CARC 178 Patient has not met the required spend down requirements.
CARC 179 Patient has not met the required waiting requirements. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 180 Patient has not met the required residency requirements.
CARC 181 Procedure code was invalid on the date of service.
CARC 182 Procedure modifier was invalid on the date of service.
CARC 183 The referring provider is not eligible to refer the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 184 The prescribing/ordering provider is not eligible to prescribe/order the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 185 The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 186 Level of care change adjustment.
CARC 187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)
CARC 188 This product/procedure is only covered when used according to FDA recommendations.
CARC 189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service.
CARC 190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.
CARC 192 Non standard adjustment code from paper remittance. Usage: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment.
CARC 193 Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.
CARC 194 Anesthesia performed by the operating physician, the assistant surgeon or the attending physician.
CARC 195 Refund issued to an erroneous priority payer for this claim/service.
CARC 197 Precertification/authorization/notification/pre-treatment absent.
CARC 198 Precertification/notification/authorization/pre-treatment exceeded.
CARC 199 Revenue code and Procedure code do not match.
CARC 200 Expenses incurred during lapse in coverage.
CARC 201 Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. (Use only with Group Code PR). 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.)
CARC 202 Non-covered personal comfort or convenience services.
CARC 203 Discontinued or reduced service.
CARC 204 This service/equipment/drug is not covered under the patient's current benefit plan.
CARC 205 Pharmacy discount card processing fee
CARC 206 National Provider Identifier - missing.
CARC 207 National Provider identifier - Invalid format.
CARC 208 National Provider Identifier - Not matched.
CARC 209 Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA)
CARC 210 Payment adjusted because pre-certification/authorization not received in a timely fashion
CARC 211 National Drug Codes (NDC) not eligible for rebate, are not covered.
CARC 212 Administrative surcharges are not covered.
CARC 213 Non-compliance with the physician self referral prohibition legislation or payer policy.
CARC 215 Based on subrogation of a third party settlement
CARC 216 Based on the findings of a review organization or the payer's findings.
CARC 219 Based on extent of injury. 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') for the jurisdictional regulation. 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).
CARC 222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 223 Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.
CARC 224 Patient identification compromised by identity theft. Identity verification required for processing this and future claims.
CARC 225 Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)
CARC 226 Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. 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.)
CARC 227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. 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.)
CARC 228 Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication.
CARC 229 Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Usage: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. (Use only with Group Code PR)
CARC 231 Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 232 Institutional Transfer Amount. Usage: Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions.
CARC 233 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
CARC 234 This procedure is not paid separately. 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.)
CARC 235 Sales Tax
CARC 236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
CARC 237 Legislated/Regulatory Penalty. 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.)
CARC 238 Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. (Use only with Group Code PR)
CARC 239 Claim spans eligible and ineligible periods of coverage. Rebill separate claims.
CARC 240 The diagnosis is inconsistent with the patient's birth weight. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 241 Low Income Subsidy (LIS) Co-payment Amount
CARC 242 Services not provided by network/primary care providers.
CARC 243 Services not authorized by network/primary care providers.
CARC 245 Provider performance program withhold.
CARC 246 This non-payable code is for required reporting only.
CARC 247 Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
CARC 248 Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
CARC 249 This claim has been identified as a readmission. (Use only with Group Code CO)
CARC 250 The attachment/other documentation that was received was the incorrect attachment/document. The expected attachment/document is still missing. 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).
CARC 251 The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. 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).
CARC 252 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).
CARC 253 Sequestration - reduction in federal payment.
CARC 254 Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's medical plan for further consideration.
CARC 256 Service not payable per managed care contract.
CARC 257 The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)
CARC 258 Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service.
CARC 259 Additional payment for Dental/Vision service utilization.
CARC 260 Processed under Medicaid ACA Enhanced Fee Schedule
CARC 261 The procedure or service is inconsistent with the patient's history.
CARC 262 Adjustment for delivery cost. Usage: To be used for pharmaceuticals only.
CARC 263 Adjustment for shipping cost. Usage: To be used for pharmaceuticals only.
CARC 264 Adjustment for postage cost. Usage: To be used for pharmaceuticals only.
CARC 265 Adjustment for administrative cost. Usage: To be used for pharmaceuticals only.
CARC 266 Adjustment for compound preparation cost. Usage: To be used for pharmaceuticals only.
CARC 267 Claim/service spans multiple months. 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.)
CARC 268 The claim spans two calendar years. Please resubmit one claim per calendar year.
CARC 269 Anesthesia not covered for this service/procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 270 Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's dental plan for further consideration.
CARC 271 Prior contractual reductions related to a current periodic payment as part of a contractual payment schedule when deferred amounts have been previously reported. (Use only with Group Code OA)
CARC 272 Coverage/program guidelines were not met.
CARC 273 Coverage/program guidelines were exceeded.
CARC 274 Fee/Service not payable per patient Care Coordination arrangement.
CARC 275 Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group Code PR)
CARC 276 Services denied by the prior payer(s) are not covered by this payer.
CARC 277 The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)
CARC 278 Performance program proficiency requirements not met. (Use only with Group Codes CO or PI) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 279 Services not provided by Preferred network providers. Usage: Use this code when there are member network limitations. For example, using contracted providers not in the member's 'narrow' network.
CARC 280 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.
CARC 281 Deductible waived per contractual agreement. Use only with Group Code CO.
CARC 282 The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 283 Attending provider is not eligible to provide direction of care.
CARC 284 Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services.
CARC 285 Appeal procedures not followed.
CARC 286 Appeal time limits not met
CARC 287 Referral exceeded.
CARC 288 Referral absent.
CARC 289 Services considered under the dental and medical plans, benefits not available.
CARC 290 Claim received by the dental plan, but benefits not available under this plan. Claim has been forwarded to the patient's medical plan for further consideration.
CARC 291 Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's dental plan for further consideration.
CARC 292 Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's pharmacy plan for further consideration.
CARC 293 Payment made to employer.
CARC 294 Payment made to attorney.
CARC 295 Pharmacy Direct/Indirect Remuneration (DIR)
CARC 296 Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the provider.
CARC 297 Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's vision plan for further consideration.
CARC 298 Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's vision plan for further consideration.
CARC 299 The billing provider is not eligible to receive payment for the service billed.
CARC 300 Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's behavioral health plan for further consideration.
CARC 301 Claim received by the medical plan, but benefits not available under this plan Submit these services to the patient's behavioral health plan for further consideration.
CARC 302 Precertification/notification/authorization/pre-treatment time limit has expired.
CARC 303 Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered for Qualified Medicare and Medicaid Beneficiaries. (Use only with Group Code CO)
CARC 304 Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's hearing plan for further consideration.
CARC 305 Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's hearing plan for further consideration.
CARC 306 Type of bill is inconsistent with the patient status. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC 307 Medicare Maximum Fair Price Standard Default Refund Amount Adjustment. 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.) Usage: To be used only for the Medicare Drug Price Negotiation Program.
CARC 308 Payment is adjusted due to contracted funding agreement between the payer and provider.

A codes · 5

CARC A0 Patient refund amount.
CARC A1 Claim/Service denied. 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.) Usage: Use this code only when a more specific Claim Adjustment Reason Code is not available.
CARC A5 Medicare Claim PPS Capital Cost Outlier Amount.
CARC A6 Prior hospitalization or 30 day transfer requirement not met.
CARC A8 Ungroupable DRG.

B codes · 15

CARC B1 Non-covered visits.
CARC B4 Late filing penalty.
CARC B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC B8 Alternative services were available, and should have been utilized. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC B9 Patient is enrolled in a Hospice.
CARC B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
CARC B11 The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.
CARC B12 Services not documented in patient's medical records.
CARC B13 Previously paid. Payment for this claim/service may have been provided in a previous payment.
CARC B14 Only one visit or consultation per physician per day is covered.
CARC B15 This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC B16 'New Patient' qualifications were not met.
CARC B20 Procedure/service was partially or fully furnished by another provider.
CARC B22 This payment is adjusted based on the diagnosis.
CARC B23 Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test.

P codes · 32

CARC P1 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. To be used for Property and Casualty only.
CARC P2 Not a work related injury/illness and thus not the liability of the workers' compensation carrier 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') for the jurisdictional regulation. 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). To be used for Workers' Compensation only.
CARC P3 Workers' Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. To be used for Workers' Compensation only. (Use only with Group Code PR)
CARC P4 Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. 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') for the jurisdictional regulation. 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). To be used for Workers' Compensation only
CARC P5 Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. To be used for Property and Casualty only.
CARC P6 Based on entitlement to benefits. 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') for the jurisdictional regulation. 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). To be used for Property and Casualty only.
CARC P7 The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. To be used for Property and Casualty only.
CARC P8 Claim is under investigation. 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') for the jurisdictional regulation. 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). To be used for Property and Casualty only.
CARC P9 No available or correlating CPT/HCPCS code to describe this service. To be used for Property and Casualty only.
CARC P10 Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To be used for Property and Casualty only.
CARC P11 The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. To be used for Property and Casualty only. (Use only with Group Code OA)
CARC P12 Workers' compensation jurisdictional fee schedule adjustment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). 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 Workers' Compensation only.
CARC P13 Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable. 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 Workers' Compensation only.
CARC P14 The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only.
CARC P15 Workers' Compensation Medical Treatment Guideline Adjustment. To be used for Workers' Compensation only.
CARC P16 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers' Compensation only. (Use with Group Code CO or OA)
CARC P17 Referral not authorized by attending physician per regulatory requirement. To be used for Property and Casualty only.
CARC P18 Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service. To be used for Property and Casualty only.
CARC P19 Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. To be used for Property and Casualty only.
CARC P20 Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only.
CARC P21 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.
CARC P22 Payment adjusted 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.
CARC P23 Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). 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.
CARC P24 Payment adjusted based on Preferred Provider Organization (PPO). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). 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 only. Use only with Group Code CO.
CARC P25 Payment adjusted based on Medical Provider Network (MPN). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). 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 only. (Use only with Group Code CO).
CARC P26 Payment adjusted based on Voluntary Provider network (VPN). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). 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 only. (Use only with Group Code CO).
CARC P27 Payment denied based on the Liability Coverage Benefits jurisdictional regulations and/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.
CARC P28 Payment adjusted based on the Liability Coverage Benefits jurisdictional regulations and/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.
CARC P29 Liability Benefits jurisdictional fee schedule adjustment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). 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.
CARC P30 Payment denied for exacerbation when supporting documentation was not complete. To be used for Property and Casualty only.
CARC P31 Payment denied for exacerbation when treatment exceeds time allowed. To be used for Property and Casualty only.
CARC P32 Payment adjusted due to Apportionment.

Remittance advice remark codes

A RARC adds the supplemental detail that tells you what specifically was wrong. It rarely appears alone, and it is what turns a vague CARC into an actionable correction.

M codes · 122

RARC M1 X-ray not taken within the past 12 months or near enough to the start of treatment.
RARC M2 Not paid separately when the patient is an inpatient.
RARC M3 Equipment is the same or similar to equipment already being used.
RARC M4 Alert: This is the last monthly installment payment for this durable medical equipment.
RARC M5 Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
RARC M6 Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
RARC M7 No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.
RARC M8 We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
RARC M9 Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
RARC M10 Equipment purchases are limited to the first or the tenth month of medical necessity.
RARC M11 DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
RARC M12 Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
RARC M13 Only one initial visit is covered per specialty per medical group.
RARC M14 No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.
RARC M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
RARC M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
RARC M17 Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.
RARC M18 Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home.
RARC M19 Missing oxygen certification/re-certification.
RARC M20 Missing/incomplete/invalid HCPCS.
RARC M21 Missing/incomplete/invalid place of residence for this service/item provided in a home.
RARC M22 Missing/incomplete/invalid number of miles traveled.
RARC M23 Missing invoice.
RARC M24 Missing/incomplete/invalid number of doses per vial.
RARC M25 The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
RARC M26 The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service/any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice. The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.
RARC M27 Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.
RARC M28 This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
RARC M29 Missing operative note/report.
RARC M30 Missing pathology report.
RARC M31 Missing radiology report.
RARC M32 Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.
RARC M36 This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.
RARC M37 Not covered when the patient is under age 35.
RARC M38 Alert: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges.
RARC M39 Alert: The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.
RARC M40 Claim must be assigned and must be filed by the practitioner's employer.
RARC M41 We do not pay for this as the patient has no legal obligation to pay for this.
RARC M42 The medical necessity form must be personally signed by the attending physician.
RARC M44 Missing/incomplete/invalid condition code.
RARC M45 Missing/incomplete/invalid occurrence code(s).
RARC M46 Missing/incomplete/invalid occurrence span code(s).
RARC M47 Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).
RARC M49 Missing/incomplete/invalid value code(s) or amount(s).
RARC M50 Missing/incomplete/invalid revenue code(s).
RARC M51 Missing/incomplete/invalid procedure code(s).
RARC M52 Missing/incomplete/invalid "from" date(s) of service.
RARC M53 Missing/incomplete/invalid days or units of service.
RARC M54 Missing/incomplete/invalid total charges.
RARC M55 We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
RARC M56 Missing/incomplete/invalid payer identifier.
RARC M59 Missing/incomplete/invalid "to" date(s) of service.
RARC M60 Missing Certificate of Medical Necessity.
RARC M61 We cannot pay for this as the approval period for the FDA clinical trial has expired.
RARC M62 Missing/incomplete/invalid treatment authorization code.
RARC M64 Missing/incomplete/invalid other diagnosis.
RARC M65 One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.
RARC M66 Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.
RARC M67 Missing/incomplete/invalid other procedure code(s).
RARC M69 Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
RARC M70 Alert: The NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item.
RARC M71 Total payment reduced due to overlap of tests billed.
RARC M73 The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
RARC M74 This service does not qualify for a HPSA/Physician Scarcity bonus payment.
RARC M75 Multiple automated multichannel tests performed on the same day combined for payment.
RARC M76 Missing/incomplete/invalid diagnosis or condition.
RARC M77 Missing/incomplete/invalid/inappropriate place of service.
RARC M79 Missing/incomplete/invalid charge.
RARC M80 Not covered when performed during the same session/date as a previously processed service for the patient.
RARC M81 You are required to code to the highest level of specificity.
RARC M82 Service is not covered when patient is under age 50.
RARC M83 Service is not covered unless the patient is classified as at high risk.
RARC M84 Medical code sets used must be the codes in effect at the time of service.
RARC M85 Subjected to review of physician evaluation and management services.
RARC M86 Service denied because payment already made for same/similar procedure within set time frame.
RARC M87 Claim/service(s) subjected to CFO-CAP prepayment review.
RARC M89 Not covered more than once under age 40.
RARC M90 Not covered more than once in a 12 month period.
RARC M91 Lab procedures with different CLIA certification numbers must be billed on separate claims.
RARC M93 Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
RARC M94 Information supplied does not support a break in therapy. A new capped rental period will not begin.
RARC M95 Services subjected to Home Health Initiative medical review/cost report audit.
RARC M96 The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.
RARC M97 Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
RARC M99 Missing/incomplete/invalid Universal Product Number/Serial Number.
RARC M100 We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug.
RARC M102 Service not performed on equipment approved by the FDA for this purpose.
RARC M103 Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.
RARC M104 Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.
RARC M105 Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.
RARC M107 Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
RARC M109 We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
RARC M111 We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
RARC M112 Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.
RARC M113 Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
RARC M114 This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.
RARC M115 This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
RARC M116 Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.
RARC M117 Not covered unless submitted via electronic claim.
RARC M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC)
RARC M121 We pay for this service only when performed with a covered cryosurgical ablation.
RARC M122 Missing/incomplete/invalid level of subluxation.
RARC M123 Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
RARC M124 Missing indication of whether the patient owns the equipment that requires the part or supply.
RARC M125 Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
RARC M126 Missing/incomplete/invalid individual lab codes included in the test.
RARC M127 Missing patient medical record for this service.
RARC M129 Missing/incomplete/invalid indicator of x?ray availability for review.
RARC M130 Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
RARC M131 Missing physician financial relationship form.
RARC M132 Missing pacemaker registration form.
RARC M133 Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
RARC M134 Performed by a facility/supplier in which the provider has a financial interest.
RARC M135 Missing/incomplete/invalid plan of treatment.
RARC M136 Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
RARC M137 Part B coinsurance under a demonstration project or pilot program.
RARC M138 Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.
RARC M139 Denied services exceed the coverage limit for the demonstration.
RARC M141 Missing physician certified plan of care.
RARC M142 Missing American Diabetes Association Certificate of Recognition.
RARC M143 The provider must update license information with the payer.
RARC M144 Pre-/post-operative care payment is included in the allowance for the surgery/procedure.

MA codes · 110

RARC MA01 Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.
RARC MA02 Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice.
RARC 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.
RARC MA07 Alert: The claim information has also been forwarded to Medicaid for review.
RARC MA08 Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
RARC MA09 Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.
RARC MA10 Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.
RARC MA12 You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).
RARC MA13 Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
RARC MA14 Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.
RARC MA15 Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
RARC MA16 The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
RARC MA17 We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.
RARC MA18 Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.
RARC MA19 Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer.
RARC MA20 Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.
RARC MA21 SSA records indicate mismatch with name and sex.
RARC MA22 Payment of less than $1.00 suppressed.
RARC MA23 Demand bill approved as result of medical review.
RARC MA24 Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
RARC MA25 A patient may not elect to change a hospice provider more than once in a benefit period.
RARC MA26 Alert: Our records indicate that you were previously informed of this rule.
RARC MA27 Missing/incomplete/invalid entitlement number or name shown on the claim.
RARC MA28 Alert: Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.
RARC MA30 Missing/incomplete/invalid type of bill.
RARC MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
RARC MA32 Missing/incomplete/invalid number of covered days during the billing period.
RARC MA33 Missing/incomplete/invalid non-covered days during the billing period.
RARC MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
RARC MA35 Missing/incomplete/invalid number of lifetime reserve days.
RARC MA36 Missing/incomplete/invalid patient name.
RARC MA37 Missing/incomplete/invalid patient's address.
RARC MA39 Missing/incomplete/invalid gender.
RARC MA40 Missing/incomplete/invalid admission date.
RARC MA41 Missing/incomplete/invalid admission type.
RARC MA42 Missing/incomplete/invalid admission source.
RARC MA43 Missing/incomplete/invalid patient status.
RARC MA44 Alert: No appeal rights. Adjudicative decision based on law.
RARC MA45 Alert: As previously advised, a portion or all of your payment is being held in a special account.
RARC MA46 Alert: The new information was considered but additional payment will not be issued.
RARC MA47 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.
RARC MA48 Missing/incomplete/invalid name or address of responsible party or primary payer.
RARC MA50 Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
RARC MA53 Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
RARC MA54 Physician certification or election consent for hospice care not received timely.
RARC MA55 Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
RARC MA56 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.
RARC MA57 Patient submitted written request to revoke his/her election for religious non-medical health care services.
RARC MA58 Missing/incomplete/invalid release of information indicator.
RARC MA59 Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.
RARC MA60 Missing/incomplete/invalid patient relationship to insured.
RARC MA61 Missing/incomplete/invalid social security number.
RARC MA62 Alert: This is a telephone review decision.
RARC MA63 Missing/incomplete/invalid principal diagnosis.
RARC MA64 Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
RARC MA65 Missing/incomplete/invalid admitting diagnosis.
RARC MA66 Missing/incomplete/invalid principal procedure code.
RARC MA67 Alert: Correction to a prior claim.
RARC MA68 Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim.
RARC MA69 Missing/incomplete/invalid remarks.
RARC MA70 Missing/incomplete/invalid provider representative signature.
RARC MA71 Missing/incomplete/invalid provider representative signature date.
RARC MA72 Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.
RARC MA73 Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
RARC MA74 Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
RARC MA75 Missing/incomplete/invalid patient or authorized representative signature.
RARC MA76 Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
RARC MA77 Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient's payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.
RARC MA79 Billed in excess of interim rate.
RARC MA80 Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.
RARC MA81 Missing/incomplete/invalid provider/supplier signature.
RARC MA83 Did not indicate whether we are the primary or secondary payer.
RARC MA84 Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.
RARC MA88 Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.
RARC MA89 Missing/incomplete/invalid patient's relationship to the insured for the primary payer.
RARC MA90 Missing/incomplete/invalid employment status code for the primary insured.
RARC MA91 Alert: This determination is the result of the appeal you filed.
RARC MA92 Missing plan information for other insurance.
RARC MA93 Non-PIP (Periodic Interim Payment) claim.
RARC MA94 Did not enter the statement "Attending physician not hospice employee" on the claim form to certify that the rendering physician is not an employee of the hospice.
RARC MA96 Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
RARC MA97 Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
RARC MA99 Missing/incomplete/invalid Medigap information.
RARC MA100 Missing/incomplete/invalid date of current illness or symptoms.
RARC MA103 Hemophilia Add On.
RARC MA106 PIP (Periodic Interim Payment) claim.
RARC MA107 Paper claim contains more than three separate data items in field 19.
RARC MA108 Paper claim contains more than one data item in field 23.
RARC MA109 Claim processed in accordance with ambulatory surgical guidelines.
RARC MA110 Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.
RARC MA111 Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.
RARC MA112 Missing/incomplete/invalid group practice information.
RARC MA113 Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.
RARC MA114 Missing/incomplete/invalid information on where the services were furnished.
RARC MA115 Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
RARC MA116 Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.
RARC MA117 This claim has been assessed a $1.00 user fee.
RARC MA118 Alert: No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable.
RARC MA120 Missing/incomplete/invalid CLIA certification number.
RARC MA121 Missing/incomplete/invalid x?ray date.
RARC MA122 Missing/incomplete/invalid initial treatment date.
RARC MA123 Your center was not selected to participate in this study, therefore, we cannot pay for these services.
RARC MA125 Per legislation governing this program, payment constitutes payment in full.
RARC MA126 Pancreas transplant not covered unless kidney transplant performed.
RARC MA128 Missing/incomplete/invalid FDA approval number.
RARC MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
RARC MA131 Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.
RARC MA132 Adjustment to the pre-demonstration rate.
RARC MA133 Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
RARC MA134 Missing/incomplete/invalid provider number of the facility where the patient resides.

N codes · 906

RARC N1 Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract, plan benefit documents or jurisdiction statutes. Refer to the URL provided in the ERA for the payer website to access the appeals process guidelines.
RARC N2 This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
RARC N3 Missing consent form.
RARC N4 Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.
RARC N5 EOB received from previous payer. Claim not on file.
RARC N6 Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B.
RARC N7 Alert: Processing of this claim/service has included consideration under Major Medical provisions.
RARC N8 Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
RARC N9 Adjustment represents the estimated amount a previous payer may pay.
RARC N10 Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
RARC N11 Denial reversed because of medical review.
RARC N12 Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.
RARC N13 Payment based on professional/technical component modifier(s).
RARC N15 Services for a newborn must be billed separately.
RARC N16 Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
RARC N19 Procedure code incidental to primary procedure.
RARC N20 Service not payable with other service rendered on the same date.
RARC N21 Alert: Your line item has been separated into multiple lines to expedite handling.
RARC N22 Alert: This procedure code was added/changed because it more accurately describes the services rendered.
RARC N23 Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
RARC N24 Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
RARC N25 This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.
RARC N26 Missing itemized bill/statement.
RARC N27 Missing/incomplete/invalid treatment number.
RARC N28 Consent form requirements not fulfilled.
RARC N30 Patient ineligible for this service.
RARC N31 Missing/incomplete/invalid prescribing provider identifier.
RARC N32 Claim must be submitted by the provider who rendered the service.
RARC N33 No record of health check prior to initiation of treatment.
RARC N34 Incorrect claim form/format for this service.
RARC N35 Program integrity/utilization review decision.
RARC N36 Claim must meet primary payer's processing requirements before we can consider payment.
RARC N37 Missing/incomplete/invalid tooth number/letter.
RARC N39 Procedure code is not compatible with tooth number/letter.
RARC N40 Missing radiology film(s)/image(s).
RARC N41 Authorization request denied
RARC N42 Missing mental health assessment.
RARC N43 Bed hold or leave days exceeded.
RARC N45 Payment based on authorized amount.
RARC N46 Missing/incomplete/invalid admission hour.
RARC N47 Claim conflicts with another inpatient stay.
RARC N48 Claim information does not agree with information received from other insurance carrier.
RARC N49 Court ordered coverage information needs validation.
RARC N50 Missing/incomplete/invalid discharge information.
RARC N51 Electronic interchange agreement not on file for provider/submitter.
RARC N52 Patient not enrolled in the billing provider's managed care plan on the date of service.
RARC N53 Missing/incomplete/invalid point of pick?up address.
RARC N54 Claim information is inconsistent with pre-certified/authorized services.
RARC N55 Procedures for billing with group/referring/performing providers were not followed.
RARC N56 Procedure code billed is not correct/valid for the services billed or the date of service billed.
RARC N57 Missing/incomplete/invalid prescribing date.
RARC N58 Missing/incomplete/invalid patient liability amount.
RARC N59 Alert: Please refer to your provider manual for additional program and provider information.
RARC N61 Rebill services on separate claims.
RARC N62 Dates of service span multiple rate periods. Resubmit separate claims.
RARC N63 Rebill services on separate claim lines.
RARC N64 The "from" and "to" dates must be different.
RARC N65 Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
RARC N67 Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient's admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.
RARC N68 Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.
RARC N69 Alert: PPS (Prospective Payment System) code changed by claims processing system.
RARC N70 Consolidated billing and payment applies.
RARC N71 Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.
RARC N72 PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
RARC N74 Resubmit with multiple claims, each claim covering services provided in only one calendar month.
RARC N75 Missing/incomplete/invalid tooth surface information.
RARC N76 Missing/incomplete/invalid number of riders.
RARC N77 Missing/incomplete/invalid designated provider number.
RARC N78 The necessary components of the child and teen checkup (EPSDT) were not completed.
RARC N79 Service billed is not compatible with patient location information.
RARC N80 Missing/incomplete/invalid prenatal screening information.
RARC N81 Procedure billed is not compatible with tooth surface code.
RARC N82 Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
RARC N83 No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
RARC N84 Alert: Further installment payments are forthcoming.
RARC N85 Alert: This is the final installment payment.
RARC N86 A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
RARC N87 Home use of biofeedback therapy is not covered.
RARC N88 Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.
RARC N89 Alert: Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice.
RARC N90 Covered only when performed by the attending physician.
RARC N91 Services not included in the appeal review.
RARC N92 This facility is not certified for digital mammography.
RARC N93 A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
RARC N94 Claim/Service denied because a more specific taxonomy code is required for adjudication.
RARC N95 This provider type/provider specialty may not bill this service.
RARC N96 Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.
RARC N97 Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.
RARC N98 Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.
RARC N99 Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
RARC N103 Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.
RARC N104 This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov.
RARC N105 This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI information for electronic claims processing.
RARC N106 Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.
RARC N107 Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
RARC N108 Missing/incomplete/invalid upgrade information.
RARC N109 Alert: This claim/service was chosen for complex review.
RARC N110 This facility is not certified for film mammography.
RARC N111 No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
RARC N112 This claim is excluded from your electronic remittance advice.
RARC N113 Only one initial visit is covered per physician, group practice or provider.
RARC N114 During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.
RARC N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
RARC N116 Alert: This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency's (HHA's) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.
RARC N117 This service is paid only once in a patient's lifetime.
RARC N118 This service is not paid if billed more than once every 28 days.
RARC N119 This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility (SNF) within those 28 days.
RARC N120 Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
RARC N121 Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility (SNF) stay.
RARC N122 Add-on code cannot be billed by itself.
RARC N123 Alert: This is a split service and represents a portion of the units from the originally submitted service.
RARC N124 Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.
RARC N125 Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice. The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office.
RARC N126 Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.
RARC N127 This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
RARC N128 This amount represents the prior to coverage portion of the allowance.
RARC N129 Not eligible due to the patient's age.
RARC N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
RARC N131 Total payments under multiple contracts cannot exceed the allowance for this service.
RARC N132 Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.
RARC N133 Alert: Services for predetermination and services requesting payment are being processed separately.
RARC N134 Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.
RARC N135 Record fees are the patient's responsibility and limited to the specified co-payment.
RARC N136 Alert: To obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at (602) 912-8444 or (800) 325-2548.
RARC N137 Alert: The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.
RARC N138 Alert: In the event you disagree with the Dental Advisor's opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subscriber's dental insurance carrier for a second Independent Dental Advisor Review.
RARC N139 Alert: Under 32 CFR 199.13, a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.
RARC N140 Alert: You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act as his/her representative and you disagree with the Dental Advisor's opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.
RARC N141 The patient was not residing in a long-term care facility during all or part of the service dates billed.
RARC N142 The original claim was denied. Resubmit a new claim, not a replacement claim.
RARC N143 The patient was not in a hospice program during all or part of the service dates billed.
RARC N144 The rate changed during the dates of service billed.
RARC N146 Missing screening document.
RARC N147 Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request.
RARC N148 Missing/incomplete/invalid date of last menstrual period.
RARC N149 Rebill all applicable services on a single claim.
RARC N150 Missing/incomplete/invalid model number.
RARC N151 Telephone contact services will not be paid until the face-to-face contact requirement has been met.
RARC N152 Missing/incomplete/invalid replacement claim information.
RARC N153 Missing/incomplete/invalid room and board rate.
RARC N154 Alert: This payment was delayed for correction of provider's mailing address.
RARC N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
RARC N156 Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
RARC N157 Transportation to/from this destination is not covered.
RARC N158 Transportation in a vehicle other than an ambulance is not covered.
RARC N159 Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
RARC N160 The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
RARC N161 This drug/service/supply is covered only when the associated service is covered.
RARC N162 Alert: Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information will result in a denial of payment in the near future.
RARC N163 Medical record does not support code billed per the code definition.
RARC N167 Charges exceed the post?transplant coverage limit.
RARC N170 A new/revised/renewed certificate of medical necessity is needed.
RARC N171 Payment for repair or replacement is not covered or has exceeded the purchase price.
RARC N172 The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
RARC N173 No qualifying hospital stay dates were provided for this episode of care.
RARC N174 This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.
RARC N175 Missing review organization approval
RARC N176 Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service.
RARC N177 Alert: We did not send this claim to patient's other insurer. They have indicated no additional payment can be made.
RARC N178 Missing pre-operative images/visual field results.
RARC N179 Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.
RARC N180 This item or service does not meet the criteria for the category under which it was billed.
RARC N181 Additional information is required from another provider involved in this service.
RARC N182 This claim/service must be billed according to the schedule for this plan.
RARC N183 Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits.
RARC N184 Rebill technical and professional components separately.
RARC N185 Alert: Do not resubmit this claim/service.
RARC N186 Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
RARC N187 Alert: You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.
RARC N188 The approved level of care does not match the procedure code submitted.
RARC N189 Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.
RARC N190 Missing contract indicator.
RARC N191 The provider must update insurance information directly with payer.
RARC N192 Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.
RARC N193 Alert: Specific federal/state/local program may cover this service through another payer.
RARC N194 Technical component not paid if provider does not own the equipment used.
RARC N195 The technical component must be billed separately.
RARC N196 Alert: Patient eligible to apply for other coverage which may be primary.
RARC N197 The subscriber must update insurance information directly with payer.
RARC N198 Rendering provider must be affiliated with the pay-to provider.
RARC N199 Additional payment/recoupment approved based on payer-initiated review/audit.
RARC N200 The professional component must be billed separately.
RARC N202 Alert: Additional information/explanation will be sent separately.
RARC N203 Missing/incomplete/invalid anesthesia time/units.
RARC N204 Services under review for possible pre-existing condition. Send medical records for prior 12 months.
RARC N205 Information provided was illegible.
RARC N206 The supporting documentation does not match the information sent on the claim.
RARC N207 Missing/incomplete/invalid weight.
RARC N208 Missing/incomplete/invalid DRG code.
RARC N209 Missing/incomplete/invalid taxpayer identification number (TIN).
RARC N210 Alert: You may appeal this decision.
RARC N211 Alert: You may not appeal this decision.
RARC N212 Charges processed under a Point of Service benefit.
RARC N213 Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
RARC N214 Missing/incomplete/invalid history of the related initial surgical procedure(s)
RARC N215 Alert: A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determination.
RARC N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
RARC N217 We pay only one site of service per provider per claim.
RARC N218 You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract or coverage manual.
RARC N219 Payment based on previous payer's allowed amount.
RARC N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
RARC N221 Missing Admitting History and Physical report.
RARC N222 Incomplete/invalid Admitting History and Physical report.
RARC N223 Missing documentation of benefit to the patient during initial treatment period.
RARC N224 Incomplete/invalid documentation of benefit to the patient during initial treatment period.
RARC N226 Incomplete/invalid American Diabetes Association Certificate of Recognition.
RARC N227 Incomplete/invalid Certificate of Medical Necessity.
RARC N228 Incomplete/invalid consent form.
RARC N229 Incomplete/invalid contract indicator.
RARC N230 Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
RARC N231 Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
RARC N232 Incomplete/invalid itemized bill/statement.
RARC N233 Incomplete/invalid operative note/report.
RARC N234 Incomplete/invalid oxygen certification/re?certification.
RARC N235 Incomplete/invalid pacemaker registration form.
RARC N236 Incomplete/invalid pathology report.
RARC N237 Incomplete/invalid patient medical record for this service.
RARC N238 Incomplete/invalid physician certified plan of care
RARC N239 Incomplete/invalid physician financial relationship form.
RARC N240 Incomplete/invalid radiology report.
RARC N241 Incomplete/invalid review organization approval.
RARC N242 Incomplete/invalid radiology film(s)/image(s).
RARC N243 Incomplete/invalid/not approved screening document.
RARC N244 Incomplete/Invalid pre-operative images/visual field results.
RARC N245 Incomplete/invalid plan information for other insurance.
RARC N246 State regulated patient payment limitations apply to this service.
RARC N247 Missing/incomplete/invalid assistant surgeon taxonomy.
RARC N248 Missing/incomplete/invalid assistant surgeon name.
RARC N249 Missing/incomplete/invalid assistant surgeon primary identifier.
RARC N250 Missing/incomplete/invalid assistant surgeon secondary identifier.
RARC N251 Missing/incomplete/invalid attending provider taxonomy.
RARC N252 Missing/incomplete/invalid attending provider name.
RARC N253 Missing/incomplete/invalid attending provider primary identifier.
RARC N254 Missing/incomplete/invalid attending provider secondary identifier.
RARC N255 Missing/incomplete/invalid billing provider taxonomy.
RARC N256 Missing/incomplete/invalid billing provider/supplier name.
RARC N257 Missing/incomplete/invalid billing provider/supplier primary identifier.
RARC N258 Missing/incomplete/invalid billing provider/supplier address.
RARC N259 Missing/incomplete/invalid billing provider/supplier secondary identifier.
RARC N260 Missing/incomplete/invalid billing provider/supplier contact information.
RARC N261 Missing/incomplete/invalid operating provider name.
RARC N262 Missing/incomplete/invalid operating provider primary identifier.
RARC N263 Missing/incomplete/invalid operating provider secondary identifier.
RARC N264 Missing/incomplete/invalid ordering provider name.
RARC N265 Missing/incomplete/invalid ordering provider primary identifier.
RARC N266 Missing/incomplete/invalid ordering provider address.
RARC N267 Missing/incomplete/invalid ordering provider secondary identifier.
RARC N268 Missing/incomplete/invalid ordering provider contact information.
RARC N269 Missing/incomplete/invalid other provider name.
RARC N270 Missing/incomplete/invalid other provider primary identifier.
RARC N271 Missing/incomplete/invalid other provider secondary identifier.
RARC N272 Missing/incomplete/invalid other payer attending provider identifier.
RARC N273 Missing/incomplete/invalid other payer operating provider identifier.
RARC N274 Missing/incomplete/invalid other payer other provider identifier.
RARC N275 Missing/incomplete/invalid other payer purchased service provider identifier.
RARC N276 Missing/incomplete/invalid other payer referring provider identifier.
RARC N277 Missing/incomplete/invalid other payer rendering provider identifier.
RARC N278 Missing/incomplete/invalid other payer service facility provider identifier.
RARC N279 Missing/incomplete/invalid pay-to provider name.
RARC N280 Missing/incomplete/invalid pay-to provider primary identifier.
RARC N281 Missing/incomplete/invalid pay-to provider address.
RARC N282 Missing/incomplete/invalid pay-to provider secondary identifier.
RARC N283 Missing/incomplete/invalid purchased service provider identifier.
RARC N284 Missing/incomplete/invalid referring provider taxonomy.
RARC N285 Missing/incomplete/invalid referring provider name.
RARC N286 Missing/incomplete/invalid referring provider primary identifier.
RARC N287 Missing/incomplete/invalid referring provider secondary identifier.
RARC N288 Missing/incomplete/invalid rendering provider taxonomy.
RARC N289 Missing/incomplete/invalid rendering provider name.
RARC N290 Missing/incomplete/invalid rendering provider primary identifier.
RARC N291 Missing/incomplete/invalid rendering provider secondary identifier.
RARC N292 Missing/incomplete/invalid service facility name.
RARC N293 Missing/incomplete/invalid service facility primary identifier.
RARC N294 Missing/incomplete/invalid service facility primary address.
RARC N295 Missing/incomplete/invalid service facility secondary identifier.
RARC N296 Missing/incomplete/invalid supervising provider name.
RARC N297 Missing/incomplete/invalid supervising provider primary identifier.
RARC N298 Missing/incomplete/invalid supervising provider secondary identifier.
RARC N299 Missing/incomplete/invalid occurrence date(s).
RARC N300 Missing/incomplete/invalid occurrence span date(s).
RARC N301 Missing/incomplete/invalid procedure date(s).
RARC N302 Missing/incomplete/invalid other procedure date(s).
RARC N303 Missing/incomplete/invalid principal procedure date.
RARC N304 Missing/incomplete/invalid dispensed date.
RARC N305 Missing/incomplete/invalid injury/accident date.
RARC N306 Missing/incomplete/invalid acute manifestation date.
RARC N307 Missing/incomplete/invalid adjudication or payment date.
RARC N308 Missing/incomplete/invalid appliance placement date.
RARC N309 Missing/incomplete/invalid assessment date.
RARC N310 Missing/incomplete/invalid assumed or relinquished care date.
RARC N311 Missing/incomplete/invalid authorized to return to work date.
RARC N312 Missing/incomplete/invalid begin therapy date.
RARC N313 Missing/incomplete/invalid certification revision date.
RARC N314 Missing/incomplete/invalid diagnosis date.
RARC N315 Missing/incomplete/invalid disability from date.
RARC N316 Missing/incomplete/invalid disability to date.
RARC N317 Missing/incomplete/invalid discharge hour.
RARC N318 Missing/incomplete/invalid discharge or end of care date.
RARC N319 Missing/incomplete/invalid hearing or vision prescription date.
RARC N320 Missing/incomplete/invalid Home Health Certification Period.
RARC N321 Missing/incomplete/invalid last admission period.
RARC N322 Missing/incomplete/invalid last certification date.
RARC N323 Missing/incomplete/invalid last contact date.
RARC N324 Missing/incomplete/invalid last seen/visit date.
RARC N325 Missing/incomplete/invalid last worked date.
RARC N326 Missing/incomplete/invalid last x?ray date.
RARC N327 Missing/incomplete/invalid other insured birth date.
RARC N328 Missing/incomplete/invalid Oxygen Saturation Test date.
RARC N329 Missing/incomplete/invalid patient birth date.
RARC N330 Missing/incomplete/invalid patient death date.
RARC N331 Missing/incomplete/invalid physician order date.
RARC N332 Missing/incomplete/invalid prior hospital discharge date.
RARC N333 Missing/incomplete/invalid prior placement date.
RARC N334 Missing/incomplete/invalid re-evaluation date.
RARC N335 Missing/incomplete/invalid referral date.
RARC N336 Missing/incomplete/invalid replacement date.
RARC N337 Missing/incomplete/invalid secondary diagnosis date.
RARC N338 Missing/incomplete/invalid shipped date.
RARC N339 Missing/incomplete/invalid similar illness or symptom date.
RARC N340 Missing/incomplete/invalid subscriber birth date.
RARC N341 Missing/incomplete/invalid surgery date.
RARC N342 Missing/incomplete/invalid test performed date.
RARC N343 Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.
RARC N344 Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
RARC N345 Date range not valid with units submitted.
RARC N346 Missing/incomplete/invalid oral cavity designation code.
RARC N347 Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer.
RARC N348 You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
RARC N349 The administration method and drug must be reported to adjudicate this service.
RARC N350 Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
RARC N351 Service date outside of the approved treatment plan service dates.
RARC N352 Alert: There are no scheduled payments for this service. Submit a claim for each patient visit.
RARC N353 Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.
RARC N354 Incomplete/invalid invoice.
RARC N355 Alert: The law permits exceptions to the refund requirement in two cases: - If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or - If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service. If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position. If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision. The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination. The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days
RARC N356 Not covered when performed with, or subsequent to, a non?covered service.
RARC N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
RARC N358 Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
RARC N359 Missing/incomplete/invalid height.
RARC N360 Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim.
RARC N362 The number of Days or Units of Service exceeds our acceptable maximum.
RARC N363 Alert: in the near future we are implementing new policies/procedures that would affect this determination.
RARC N364 Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.
RARC N366 Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.
RARC N367 Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.
RARC N368 You must appeal the determination of the previously adjudicated claim.
RARC N369 Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.
RARC N370 Billing exceeds the rental months covered/approved by the payer.
RARC N371 Alert: title of this equipment must be transferred to the patient.
RARC N372 Only reasonable and necessary maintenance/service charges are covered.
RARC N373 It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf.
RARC N374 Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.
RARC N375 Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.
RARC N376 Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.
RARC N377 Payment based on a processed replacement claim.
RARC N378 Missing/incomplete/invalid prescription quantity.
RARC N379 Claim level information does not match line level information.
RARC N380 The original claim has been processed, submit a corrected claim.
RARC N381 Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.
RARC N382 Missing/incomplete/invalid patient identifier.
RARC N383 Not covered when deemed cosmetic.
RARC N384 Records indicate that the referenced body part/tooth has been removed in a previous procedure.
RARC N385 Notification of admission was not timely according to published plan procedures.
RARC N386 This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy.
RARC N387 Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.
RARC N388 Missing/incomplete/invalid prescription number.
RARC N389 Duplicate prescription number submitted.
RARC N390 This service/report cannot be billed separately.
RARC N391 Missing emergency department records.
RARC N392 Incomplete/invalid emergency department records.
RARC N393 Missing progress notes/report.
RARC N394 Incomplete/invalid progress notes/report.
RARC N395 Missing laboratory report.
RARC N396 Incomplete/invalid laboratory report.
RARC N397 Benefits are not available for incomplete service(s)/undelivered item(s).
RARC N398 Missing elective consent form.
RARC N399 Incomplete/invalid elective consent form.
RARC N400 Alert: Electronically enabled providers should submit claims electronically.
RARC N401 Missing periodontal charting.
RARC N402 Incomplete/invalid periodontal charting.
RARC N403 Missing facility certification.
RARC N404 Incomplete/invalid facility certification.
RARC N405 This service is only covered when the donor's insurer(s) do not provide coverage for the service.
RARC N406 This service is only covered when the recipient's insurer(s) do not provide coverage for the service.
RARC N407 You are not an approved submitter for this transmission format.
RARC N408 This payer does not cover deductibles assessed by a previous payer.
RARC 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.
RARC N410 Not covered unless the prescription changes.
RARC N411 This service is allowed one time in a 6-month period.
RARC N412 This service is allowed 2 times in a 12-month period.
RARC N413 This service is allowed 2 times in a benefit year.
RARC N414 This service is allowed 4 times in a 12-month period.
RARC N415 This service is allowed 1 time in an 18-month period.
RARC N416 This service is allowed 1 time in a 3-year period.
RARC N417 This service is allowed 1 time in a 5-year period.
RARC N418 Misrouted claim. See the payer's claim submission instructions.
RARC N419 Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.
RARC N420 Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
RARC N421 Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.
RARC N422 Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program.
RARC N423 Claim payment was the result of a payer's retroactive adjustment due to a non standard program.
RARC N424 Patient does not reside in the geographic area required for this type of payment.
RARC N425 Statutorily excluded service(s).
RARC N426 No coverage when self?administered.
RARC N427 Payment for eyeglasses or contact lenses can be made only after cataract surgery.
RARC N428 Not covered when performed in this place of service.
RARC N429 Not covered when considered routine.
RARC N430 Procedure code is inconsistent with the units billed.
RARC N431 Not covered with this procedure.
RARC N432 Alert: Adjustment based on a Recovery Audit.
RARC N433 Resubmit this claim using only your National Provider Identifier (NPI).
RARC N434 Missing/Incomplete/Invalid Present on Admission indicator.
RARC N435 Exceeds number/frequency approved /allowed within time period without support documentation.
RARC N436 The injury claim has not been accepted and a mandatory medical reimbursement has been made.
RARC N437 Alert: If the injury claim is accepted, these charges will be reconsidered.
RARC N438 This jurisdiction only accepts paper claims.
RARC N439 Missing anesthesia physical status report/indicators.
RARC N440 Incomplete/invalid anesthesia physical status report/indicators.
RARC N441 This missed/cancelled appointment is not covered.
RARC N442 Payment based on an alternate fee schedule.
RARC N443 Missing/incomplete/invalid total time or begin/end time.
RARC N444 Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation.
RARC N445 Missing document for actual cost or paid amount.
RARC N446 Incomplete/invalid document for actual cost or paid amount.
RARC N447 Payment is based on a generic equivalent as required documentation was not provided.
RARC N448 This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.
RARC N449 Payment based on a comparable drug/service/supply.
RARC N450 Covered only when performed by the primary treating physician or the designee.
RARC N451 Missing Admission Summary Report.
RARC N452 Incomplete/invalid Admission Summary Report.
RARC N453 Missing Consultation Report.
RARC N454 Incomplete/invalid Consultation Report.
RARC N455 Missing Physician Order.
RARC N456 Incomplete/invalid Physician Order.
RARC N457 Missing Diagnostic Report.
RARC N458 Incomplete/invalid Diagnostic Report.
RARC N459 Missing Discharge Summary.
RARC N460 Incomplete/invalid Discharge Summary.
RARC N461 Missing Nursing Notes.
RARC N462 Incomplete/invalid Nursing Notes.
RARC N463 Missing support data for claim.
RARC N464 Incomplete/invalid support data for claim.
RARC N465 Missing Physical Therapy Notes/Report.
RARC N466 Incomplete/invalid Physical Therapy Notes/Report.
RARC N467 Missing Tests and Analysis Report.
RARC N468 Incomplete/invalid Report of Tests and Analysis Report.
RARC N469 Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
RARC N470 This payment will complete the mandatory medical reimbursement limit.
RARC N471 Missing/incomplete/invalid HIPPS Rate Code.
RARC N472 Payment for this service has been issued to another provider.
RARC N473 Missing certification.
RARC N474 Incomplete/invalid certification.
RARC N475 Missing completed referral form.
RARC N476 Incomplete/invalid completed referral form.
RARC N477 Missing Dental Models.
RARC N478 Incomplete/invalid Dental Models.
RARC N479 Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
RARC N480 Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
RARC N481 Missing Models.
RARC N482 Incomplete/invalid Models.
RARC N485 Missing Physical Therapy Certification.
RARC N486 Incomplete/invalid Physical Therapy Certification.
RARC N487 Missing Prosthetics or Orthotics Certification.
RARC N488 Incomplete/invalid Prosthetics or Orthotics Certification.
RARC N489 Missing referral form.
RARC N490 Incomplete/invalid referral form.
RARC N491 Missing/Incomplete/Invalid Exclusionary Rider Condition
RARC N492 Alert: A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge.
RARC N493 Missing Doctor First Report of Injury.
RARC N494 Incomplete/invalid Doctor First Report of Injury.
RARC N495 Missing Supplemental Medical Report.
RARC N496 Incomplete/invalid Supplemental Medical Report.
RARC N497 Missing Medical Permanent Impairment or Disability Report.
RARC N498 Incomplete/invalid Medical Permanent Impairment or Disability Report.
RARC N499 Missing Medical Legal Report.
RARC N500 Incomplete/invalid Medical Legal Report.
RARC N501 Missing Vocational Report.
RARC N502 Incomplete/invalid Vocational Report.
RARC N503 Missing Work Status Report.
RARC N504 Incomplete/invalid Work Status Report.
RARC N505 Alert: This response includes only services that could be estimated in real-time. No estimate will be provided for the services that could not be estimated in real-time.
RARC N506 Alert: This is an estimate of the member's liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. This is not a pre-authorization or a guarantee of payment.
RARC N507 Plan distance requirements have not been met.
RARC N508 Alert: This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.
RARC N509 Alert: A current inquiry shows the member's Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
RARC N510 Alert: A current inquiry shows the member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
RARC N511 Alert: Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time.
RARC N512 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.
RARC N513 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.
RARC N516 Records indicate a mismatch between the submitted NPI and EIN.
RARC N517 Resubmit a new claim with the requested information.
RARC N518 No separate payment for accessories when furnished for use with oxygen equipment.
RARC N519 Invalid combination of HCPCS modifiers.
RARC N520 Alert: Payment made from a Consumer Spending Account.
RARC N521 Mismatch between the submitted provider information and the provider information stored in our system.
RARC N522 Duplicate of a claim processed, or to be processed, as a crossover claim.
RARC N523 The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid.
RARC N524 Based on policy this payment constitutes payment in full.
RARC N525 These services are not covered when performed within the global period of another service.
RARC N526 Not qualified for recovery based on employer size.
RARC N527 We processed this claim as the primary payer prior to receiving the recovery demand.
RARC N528 Patient is entitled to benefits for Institutional Services only.
RARC N529 Patient is entitled to benefits for Professional Services only.
RARC N530 Not Qualified for Recovery based on enrollment information.
RARC N531 Not qualified for recovery based on direct payment of premium.
RARC N532 Not qualified for recovery based on disability and working status.
RARC N533 Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
RARC N534 This is an individual policy, the employer does not participate in plan sponsorship.
RARC N535 Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
RARC N536 We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us.
RARC N537 We have examined claims history and no records of the services have been found.
RARC N538 A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
RARC N539 Alert: We processed appeals/waiver requests on your behalf and that request has been denied.
RARC N540 Payment adjusted based on the interrupted stay policy.
RARC N541 Mismatch between the submitted insurance type code and the information stored in our system.
RARC N542 Missing income verification.
RARC N543 Incomplete/invalid income verification.
RARC N544 Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future.
RARC N545 Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
RARC N546 Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
RARC N547 A refund request (Frequency Type Code 8) was processed previously.
RARC N548 Alert: Patient's calendar year deductible has been met.
RARC N549 Alert: Patient's calendar year out-of-pocket maximum has been met.
RARC N550 Alert: You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future.
RARC N551 Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.
RARC N552 Payment adjusted to reverse a previous withhold/bonus amount.
RARC N554 Missing/Incomplete/Invalid Family Planning Indicator.
RARC N555 Missing medication list.
RARC N556 Incomplete/invalid medication list.
RARC N557 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected.
RARC N558 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received.
RARC N559 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located.
RARC N560 The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.
RARC N561 The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.
RARC N562 The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.
RARC N563 Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.
RARC N564 Patient did not meet the inclusion criteria for the demonstration project or pilot program.
RARC N565 Alert: This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed.
RARC N566 Alert: This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.
RARC N567 Not covered when considered preventative.
RARC N568 Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.
RARC N569 Not covered when performed for the reported diagnosis.
RARC N570 Missing/incomplete/invalid credentialing data.
RARC N571 Alert: Payment will be issued quarterly by another payer/contractor.
RARC N572 This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
RARC N573 Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.
RARC N574 Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider.
RARC N575 Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
RARC N576 Services not related to the specific incident/claim/accident/loss being reported.
RARC N577 Personal Injury Protection (PIP) Coverage.
RARC N578 Coverages do not apply to this loss.
RARC N579 Medical Payments Coverage (MPC).
RARC N580 Determination based on the provisions of the insurance policy.
RARC N581 Investigation of coverage eligibility is pending.
RARC N582 Benefits suspended pending the patient's cooperation.
RARC N583 Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
RARC N584 Not covered based on the insured's noncompliance with policy or statutory conditions.
RARC N585 Benefits are no longer available based on a final injury settlement.
RARC N586 The injured party does not qualify for benefits.
RARC N587 Policy benefits have been exhausted.
RARC N588 The patient has instructed that medical claims/bills are not to be paid.
RARC N589 Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by the use of a drug.
RARC N590 Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
RARC N591 Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
RARC N592 Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
RARC N593 Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
RARC N594 Records reflect the injured party did not complete an Application for Benefits for this loss.
RARC N595 Records reflect the injured party did not complete an Assignment of Benefits for this loss.
RARC N596 Records reflect the injured party did not complete a Medical Authorization for this loss.
RARC N597 Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
RARC N598 Health care policy coverage is primary.
RARC N599 Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.
RARC N600 Adjusted based on the applicable fee schedule for the region in which the service was rendered.
RARC N601 In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii.
RARC N602 Adjusted based on the Redbook maximum allowance.
RARC N603 This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage.
RARC N604 In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR.
RARC N605 This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
RARC N606 The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
RARC N607 Service provided for non-compensable condition(s).
RARC N608 The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6.
RARC N609 80% of the provider's billed amount is being recommended for payment according to Act 6.
RARC N610 Alert: Payment based on an appropriate level of care.
RARC N611 Claim in litigation. Contact insurer for more information.
RARC N612 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
RARC N613 Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.
RARC N614 Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
RARC N615 Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
RARC N616 Alert: This enrollee is in the first month of the advance premium tax credit grace period.
RARC N617 This enrollee is in the second or third month of the advance premium tax credit grace period.
RARC N618 Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
RARC N619 Coverage terminated for non-payment of premium.
RARC N620 Alert: This procedure code is for quality reporting/informational purposes only.
RARC N621 Charges for Jurisdiction required forms, reports, or chart notes are not payable.
RARC N622 Not covered based on the date of injury/accident.
RARC N623 Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
RARC N624 The associated Workers' Compensation claim has been withdrawn.
RARC N625 Missing/Incomplete/Invalid Workers' Compensation Claim Number.
RARC N626 New or established patient E/M codes are not payable with chiropractic care codes.
RARC N628 Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
RARC N629 Reviews/documentation/notes/summaries/reports/charts not requested.
RARC N630 Referral not authorized by attending physician).
RARC N631 Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
RARC N633 Additional anesthesia time units are not allowed.
RARC N634 The allowance is calculated based on anesthesia time units.
RARC N635 The Allowance is calculated based on the anesthesia base units plus time.
RARC N636 Adjusted because this is reimbursable only once per injury.
RARC N637 Consultations are not allowed once treatment has been rendered by the same provider.
RARC N638 Reimbursement has been made according to the home health fee schedule.
RARC N639 Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
RARC N640 Exceeds number/frequency approved/allowed within time period.
RARC N641 Reimbursement has been based on the number of body areas rated.
RARC N642 Adjusted when billed as individual tests instead of as a panel.
RARC N643 The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
RARC N644 Reimbursement has been made according to the bilateral procedure rule.
RARC N645 Mark-up allowance.
RARC N646 Reimbursement has been adjusted based on the guidelines for an assistant.
RARC N647 Adjusted based on diagnosis-related group (DRG).
RARC N648 Adjusted based on Stop Loss.
RARC N649 Payment based on invoice.
RARC N650 This policy was not in effect for this date of loss. No coverage is available.
RARC N651 No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
RARC N652 The date of service is before the date of loss.
RARC N653 The date of injury does not match the reported date of loss.
RARC N654 Adjusted based on achievement of maximum medical improvement (MMI).
RARC N655 Payment based on provider's geographic region.
RARC N656 An interest payment is being made because benefits are being paid outside the statutory requirement.
RARC N657 This should be billed with the appropriate code for these services.
RARC N658 The billed service(s) are not considered medical expenses.
RARC N659 This item is exempt from sales tax.
RARC N660 Sales tax has been included in the reimbursement.
RARC N661 Documentation does not support that the services rendered were medically necessary.
RARC N662 Alert: Consideration of payment will be made upon receipt of a final bill.
RARC N663 Adjusted based on an agreed amount.
RARC N664 Adjusted based on a legal settlement.
RARC N665 Services by an unlicensed provider are not reimbursable.
RARC N666 Only one evaluation and management code at this service level is covered during the course of care.
RARC N667 Missing prescription.
RARC N668 Incomplete/invalid prescription.
RARC N669 Adjusted based on the Medicare fee schedule.
RARC N670 This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
RARC N671 Payment based on a jurisdiction cost-charge ratio.
RARC N672 Alert: Amount applied to Health Insurance Offset.
RARC N673 Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
RARC N674 Not covered unless a pre-requisite procedure/service has been provided.
RARC N675 Additional information is required from the injured party.
RARC N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
RARC N677 Alert: Films/Images will not be returned.
RARC N678 Missing post-operative images/visual field results.
RARC N679 Incomplete/Invalid post-operative images/visual field results.
RARC N680 Missing/Incomplete/Invalid date of previous dental extractions.
RARC N681 Missing/Incomplete/Invalid full arch series.
RARC N682 Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
RARC N683 Missing/Incomplete/Invalid prior treatment documentation.
RARC N684 Payment denied as this is a specialty claim submitted as a general claim.
RARC N685 Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
RARC N686 Missing/incomplete/Invalid questionnaire needed to complete payment determination.
RARC N687 Alert: This reversal is due to a retroactive disenrollment.
RARC N688 Alert: This reversal is due to a medical or utilization review decision.
RARC N689 Alert: This reversal is due to a retroactive rate change.
RARC N690 Alert: This reversal is due to a provider submitted appeal.
RARC N691 Alert: This reversal is due to a patient submitted appeal.
RARC N692 Alert: This reversal is due to an incorrect rate on the initial adjudication.
RARC N693 Alert: This reversal is due to a cancellation of the claim by the provider.
RARC N694 Alert: This reversal is due to a resubmission/change to the claim by the provider.
RARC N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
RARC N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
RARC N697 Alert: This reversal is due to a payer's retroactive contract incentive program adjustment.
RARC N698 Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage.
RARC N699 Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
RARC N700 Payment adjusted based on the Electronic Health Records (EHR) Incentive Program.
RARC N701 Payment adjusted based on the Value-based Payment Modifier.
RARC N702 Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.
RARC N703 This service is incompatible with previously adjudicated claims or claims in process.
RARC N704 Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.
RARC N705 Incomplete/invalid documentation.
RARC N706 Missing documentation.
RARC N707 Incomplete/invalid orders.
RARC N708 Missing orders.
RARC N709 Incomplete/invalid notes.
RARC N710 Missing notes.
RARC N711 Incomplete/invalid summary.
RARC N712 Missing summary.
RARC N713 Incomplete/invalid report.
RARC N714 Missing report.
RARC N715 Incomplete/invalid chart.
RARC N716 Missing chart.
RARC N717 Incomplete/Invalid documentation of face-to-face examination.
RARC N718 Missing documentation of face-to-face examination.
RARC N719 Penalty applied based on plan requirements not being met.
RARC N720 Alert: The patient overpaid you. You may need to issue the patient a refund for the difference between the patient's payment and the amount shown as patient responsibility on this notice.
RARC N721 This service is only covered when performed as part of a clinical trial.
RARC N722 Patient must use Workers' Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
RARC N723 Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.
RARC N724 Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.
RARC N725 A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
RARC N726 A conditional payment is not allowed.
RARC N727 A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
RARC N728 A workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
RARC N729 Missing patient medical/dental record for this service.
RARC N730 Incomplete/invalid patient medical/dental record for this service.
RARC N731 Incomplete/Invalid mental health assessment.
RARC N732 Services performed at an unlicensed facility are not reimbursable.
RARC N733 Regulatory surcharges are paid directly to the state.
RARC N734 The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.
RARC N736 Incomplete/invalid Sleep Study Report.
RARC N737 Missing Sleep Study Report.
RARC N738 Incomplete/invalid Vein Study Report.
RARC N739 Missing Vein Study Report.
RARC N740 The member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service.
RARC N741 This is a site neutral payment.
RARC N743 Adjusted because the services may be related to an employment accident.
RARC N744 Adjusted because the services may be related to an auto/other accident.
RARC N745 Missing Ambulance Report.
RARC N746 Incomplete/invalid Ambulance Report.
RARC N747 This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides.
RARC N748 Adjusted because the related hospital charges have not been received.
RARC N749 Missing Blood Gas Report.
RARC N750 Incomplete/invalid Blood Gas Report.
RARC N751 Adjusted because the patient is covered under a Medicare Part D plan.
RARC N752 Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC).
RARC N753 Missing/incomplete/invalid Attachment Control Number.
RARC N754 Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form.
RARC N755 Missing/incomplete/invalid ICD Indicator.
RARC N756 Missing/incomplete/invalid point of drop-off address.
RARC N757 Adjusted based on the Federal Indian Fees schedule (MLR).
RARC N758 Adjusted based on the prior authorization decision.
RARC N759 Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013.
RARC N760 This facility is not authorized to receive payment for the service(s).
RARC N761 This provider is not authorized to receive payment for the service(s).
RARC N762 This facility is not certified for Tomosynthesis (3-D) mammography.
RARC N763 The demonstration code is not appropriate for this claim; resubmit without a demonstration code.
RARC N764 Missing/incomplete/invalid Hematocrit (HCT) value.
RARC N765 This payer does not cover coinsurance assessed by a previous payer.
RARC N766 This payer does not cover co-payment assessed by a previous payer.
RARC N767 The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed.
RARC N768 Incomplete/invalid initial evaluation report.
RARC N769 A lateral diagnosis is required.
RARC N770 The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.
RARC N771 Alert: Under Federal law you cannot charge more than the limiting charge amount.
RARC N772 Alert: Rebill urgent/emergent and ancillary services separately.
RARC N773 Drug supplied not obtained from specialty vendor.
RARC N774 Alert: Refer to your Third Party Processor Agreement for specific information on fees associated with this payment type.
RARC N775 Payment adjusted based on x-ray radiograph on film.
RARC N776 This service is not a covered Telehealth service.
RARC N777 Missing Assignment of Benefits Indicator.
RARC N778 Missing Primary Care Physician Information.
RARC N779 Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received.
RARC N780 Missing/incomplete/invalid end therapy date.
RARC N781 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer.
RARC N782 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer.
RARC N783 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected copayment. This amount may be billed to a subsequent payer.
RARC N784 Missing comprehensive procedure code.
RARC N785 Missing current radiology film/images.
RARC N786 Benefit limitation for the orthodontic active and/or retention phase of treatment.
RARC N787 Alert: Under 42 CFR 410.43, an eligible Partial Hospitalization Program (PHP) patient/beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP services must be furnished in accordance with the plan of care.
RARC N788 Alert: The third-party administrator/review organization did not receive the required information.
RARC N789 Clinical Trial is not a covered benefit.
RARC N790 Provider/supplier not accredited for product/service.
RARC N791 Missing history & physical report.
RARC N792 Incomplete/invalid history & physical report.
RARC N794 Payment adjusted based on type of technology used.
RARC N795 Item must be resubmitted as a purchase.
RARC N796 Missing/incomplete/invalid Hemoglobin (Hb or Hgb) value.
RARC N797 Missing/incomplete/invalid date qualifier.
RARC N798 Submit a void request for the original claim and resubmit a new claim.
RARC N799 Submitted identifier must be an individual identifier, not group identifier.
RARC N800 Only one service date is allowed per claim.
RARC N801 Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation 42 CFR 136.
RARC N802 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located.
RARC N803 Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital.
RARC N804 Alert: The claim/service was processed through the Outpatient Code Editor (OCE).
RARC N805 Alert: The claim/service was processed through the Correct Code Editor (CCE).
RARC N806 Payment is included in the Global transplant allowance.
RARC N807 Payment adjustment based on the Merit-based Incentive Payment System (MIPS).
RARC N808 Not covered for this provider type / provider specialty.
RARC N809 Alert: The fee schedule amount for this service was adjusted based on prior competitive bidding rates. For more information, contact your local contractor.
RARC N810 Alert: Due to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit. At the conclusion or expiration of the disaster declaration, network payment rules will be reinstated.
RARC N811 Missing Federal Sequestration Reduction from Prior Payer.
RARC N812 The start service date through end service date cannot span greater than 18 months.
RARC N815 Missing/Incomplete/Invalid NDC Unit Count
RARC N816 Missing/Incomplete/Invalid NDC Unit of Measure
RARC N817 Alert: Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 - March 31, 2020.
RARC N818 Claims Dates of Service do not match Electronic Visit Verification System.
RARC N819 Patient not enrolled in Electronic Visit Verification System.
RARC N820 Electronic Visit Verification System units do not meet requirements of visit.
RARC N821 Electronic Visit Verification System visit not found.
RARC N822 Missing procedure modifier(s).
RARC N823 Incomplete/Invalid Procedure modifier(s).
RARC N824 Electronic Visit Verification (EVV) data must be submitted through EVV Vendor.
RARC N825 Early intervention guidelines were not met.
RARC N826 Patient did not meet the inclusion criteria for the Medicare Shared Savings Program.
RARC N827 Missing/Incomplete/Invalid Federal Information Processing Standard (FIPS) Code.
RARC N828 Alert: Payment is suppressed due to a contracted funding.
RARC N829 Missing/incomplete/invalid Diagnostics Exchange Z-Code Identifier.
RARC N830 Alert: The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations. As such, any amount identified with OA, CO, or PI cannot be collected from the member and may be considered provider liability or be billable to a subsequent payer. Any amount the provider collected over the identified PR amount must be refunded to the patient within applicable Federal/State timeframes. Payment amounts are eligible for dispute pursuant to any Federal/State documented appeal/grievance process(es).
RARC N831 You have not responded to requests to revalidate your provider/supplier enrollment information.
RARC N832 Duplicate occurrence code/occurrence span code.
RARC N833 Patient share of cost waived.
RARC N834 Jurisdiction exempt from sales and health tax charges.
RARC N835 Unrelated Service/procedure/treatment is reduced. The balance of this charge is the patient's responsibility.
RARC N836 Provider W9 or Payee Registration not on file.
RARC N837 Alert: Missing modifier was added.
RARC N838 Alert: Service/procedure postponed due to a federal, state, or local mandate/disaster declaration. Any amounts applied to deductible or member liability will be applied to the prior plan year from which the procedure was cancelled.
RARC N839 The procedure code was added/changed because the level of service exceeds the compensable condition(s).
RARC N840 Worker's compensation claim filed with a different state.
RARC N841 Alert: North Dakota Administrative Rule 92-01-02-50.3.
RARC N842 Alert: Patient cannot be billed for charges.
RARC N843 Missing/incomplete/invalid Core-Based Statistical Area (CBSA) code.
RARC N844 This claim, or a portion of this claim, was processed in accordance with the Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act.
RARC N845 Alert: Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act.
RARC N846 National Drug Code (NDC) supplied does not correspond to the HCPCs/CPT billed.
RARC N847 National Drug Code (NDC) billed is obsolete.
RARC N848 National Drug Code (NDC) billed cannot be associated with a product.
RARC N849 Missing Tooth Clause: Tooth missing prior to the member effective date.
RARC N850 Missing/incomplete/invalid narrative explaining/describing this service/treatment.
RARC N851 Payment reduced because services were furnished by a therapy assistant.
RARC N852 The pay-to and rendering provider tax identification numbers (TINs) do not match
RARC N853 The number of modalities performed per session exceeds our acceptable maximum.
RARC N854 Alert: If you have primary other health insurance (OHI) coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbursement.
RARC N855 This coverage is subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.
RARC N856 This coverage is not subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.
RARC N857 This claim has been adjusted/reversed. Refund any collected copayment to the member.
RARC N858 Alert: State regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim. Payment amounts are eligible for dispute following the state's documented appeal/ grievance/ arbitration process.
RARC N859 Alert: The Federal No Surprise Billing Act was applied to the processing of this claim. Payment amounts are eligible for dispute pursuant to any Federal documented appeal/ grievance/ dispute resolution process(es).
RARC N860 Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).
RARC N861 Alert: Mismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient.
RARC N862 Alert: Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge.
RARC N863 Alert: This claim is subject to the No Surprises Act (NSA). The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA.
RARC N864 Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.
RARC N865 Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating facility.
RARC N866 Alert: This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services.
RARC N867 Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.
RARC N868 Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
RARC N869 Alert: Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act.
RARC N870 Alert: In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount.
RARC N871 Alert: This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act.
RARC N872 Alert: This final payment was calculated based on a specified state law, in accordance with the No Surprises Act.
RARC N873 Alert: This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
RARC N874 Alert: This final payment was determined through open negotiation, in accordance with the No Surprises Act.
RARC N875 Alert: This final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act.
RARC N876 Alert: This item or service is covered under the plan. This is a notice of denial of payment provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate than the amount paid by the patient in cost sharing.
RARC N877 Alert: This initial payment is provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate.
RARC N878 Alert: The provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and obtained in a manner consistent with applicable Federal law. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.
RARC N879 Alert: The notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the billed services, is not permitted for these services. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.
RARC N880 Original claim closed due to changes in submitted data. Adjustment claim will be processed under a new claim number.
RARC N881 Client Obligation, patient responsibility for Home & Community Based Services (HCBS)
RARC N882 Alert: The out-of-network payment and cost sharing amounts were based on the plan's allowance because the provider or facility obtained the patient's consent to waive the balance billing protections under the No Surprises Act.
RARC N883 Alert: Processed according to state law
RARC N884 Alert: The No Surprises Act may apply to this claim. Please contact payer for instructions on how to submit information regarding whether or not the item or service was furnished during a patient visit to a participating facility.
RARC N885 Alert: This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those requirements apply. You may contact the payer to find out why it disagrees. You may appeal this adverse determination on behalf of the patient through the payer’s internal appeals and external review processes.
RARC N886 Alert: A Health Care Claim Request for Additional Information (277 RFAI) has been sent.
RARC N887 Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not paid the services at the expected Medicare reimbursable rate or type of level/service. Providers may file their appeal in writing within 60 calendar days after the date of the remittance advice. For the plan to review the appeal, the plan will need a completed signed Waiver of Liability Statement. To obtain a Waiver of Liability form, please contact your Medicare Advantage Plan. Once we receive the completed forms, we will give you a decision on your appeal within 60 calendar days.
RARC N888 Alert: An electronic request for additional information has been sent for this claim.
RARC N889 Alert: This claim was originally processed in real-time, and we sent a real-time 835 response.
RARC N890 Electronic Visit Verification Data Element Requirements were not met
RARC N891 The maximum allowable payment for this service/procedure was paid by the primary insurance. No further payment due.
RARC N892 The claim does not meet the criteria for acceptable use of the Delay Reason Code
RARC N893 Missing/incomplete/invalid child medical evaluation form/checklist.
RARC N894 Alert: These payments are made subject to a reservation of rights for the Payor to recoup or otherwise recover all or part of these payments based on any of the following: outcome of pending or future litigation/ new or updated state, federal or regulatory guidance/ any other actions that may affect the Payor's obligation to make these payments.
RARC N895 Processed based on a negotiated fee schedule for a specialty drug program.
RARC N896 Missing/incomplete/invalid trauma activation sheet.
RARC N897 Missing/incomplete/invalid proof of member payment.
RARC N898 Missing/incomplete/invalid Resource Utilization Group(s) (RUG) code(s).
RARC N899 Missing Initial Evaluation Report.
RARC N900 Missing Therapy Notes/Report.
RARC N901 Incomplete/Invalid Therapy Notes/Report.
RARC N902 Missing Health Risk Assessment (HRA).
RARC N903 Incomplete/Invalid Health Risk Assessment (HRA).
RARC N904 The transportation vendor is responsible for this claim.
RARC N905 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is not responsible for payment.
RARC N906 Service is not covered when patient is under age 45.
RARC N907 No refund because this claim has been identified as 340B-eligible with a ceiling price lower than the maximum fair price.
RARC N908 No refund because this drug has been prospectively purchased at the maximum fair price.
RARC N909 Refund amount has been calculated using a methodology that differs from the Standard Default Refund Amount calculation ((Wholesale Acquisition Cost minus Maximum Fair Price) times Quantity).
RARC N910 A refund cannot be provided for this claim at this time. Contact the manufacturer directly regarding your eligibility.
RARC N911 This claim cannot be reimbursed by the manufacturer until the Part D plan submits corrected prescription drug event data to CMS for maximum fair price validation.
RARC N912 Our records indicate that this beneficiary did not elect hospice.
RARC N913 More than one Electronic Visit Verification record exists for the date and time of this service.
RARC N914 This claim was priced and processed in accordance with California AB-72 Health care coverage.
RARC N915 Predetermination of services is not allowed under the member's plan.
RARC N916 The third party will render payment to the provider, and they will reimburse you for covered services.
RARC N917 Alternative refund amount has been calculated because the maximum fair price is below the 340B ceiling price.
RARC N918 No refund because CMS excludes prescription drug event records when a compound code indicates it is for a compounded drug.
RARC N919 Family/member out-of-pocket maximum has been met.
RARC N920 Payment to the provider has been placed on hold as a result of active contract (re)negotiation.
RARC N921 The time limit for filing a reconsideration or appeal has expired.
RARC N922 Missing primary care dentist information.
RARC N923 Not Denied - The Medicare Advantage Organization (MAO) made a payment responsibility determination.
RARC N924 Pending (Not Denied) - The Medicare Advantage Organization (MAO) has not yet made a payment responsibility determination for the service at the time the encounter record was submitted.
RARC N925 Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for the service at the time the encounter record was submitted.
RARC N926 Partially Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for one or more service lines, but not all, at the time the encounter record was submitted.
RARC N927 Missing/Incomplete/Invalid x-ray.
RARC N928 Missing/Incomplete/Invalid bitewing or periapical x-ray.
RARC N929 Missing/Incomplete/Invalid photo(s).
RARC N930 Missing/Incomplete/Invalid quadrant identifier.
RARC N931 Missing/Incomplete/Invalid pre- and/or post-operative bitewing or periapical x-ray.
RARC N932 Missing/Incomplete/Invalid pre- and/or post-operative full mouth x-ray.
RARC N933 Missing/Incomplete/Invalid pre- and/or post-operative photo(s).
RARC N934 Missing/Incomplete/Invalid full mouth x-ray.
RARC N935 Alert: Patient is no longer a Medicaid/Qualified Medicare Beneficiary.
RARC N936 This service code has been identified as the secondary or tertiary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
RARC N937 The service line denial threshold was exceeded.
RARC N938 Alert: Do not resubmit. This claim will be automatically reprocessed.
RARC N939 Alert: You may contact us for a peer-to-peer review.
RARC N940 Missing/Incomplete/Invalid pre- and/or post-operative x-ray.

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