You are required to code to the highest level of specificity.
Code type
RARC (Remark)
Category
Missing Info
Common CARC pairings
RARCs like M81 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC M81 is most often paired with.
| CARC | Meaning |
|---|---|
| 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. |
| 189 | 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service. |
| 256 | Service not payable per managed care contract. |
See the full resolution workflow for RARC M81
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every RARC and CARC pairing, plus payer-specific quirks.
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