Service denied because payment already made for same/similar procedure within set time frame.
Code type
RARC (Remark)
Category
Non-Covered Service
Common CARC pairings
RARCs like M86 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC M86 is most often paired with.
| CARC | Meaning |
|---|---|
| 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. |
| 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. |
| 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. |
| 119 | Benefit maximum for this time period or occurrence has been reached. |
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. |
| B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. |
| B14 | Only one visit or consultation per physician per day is covered. |
| B16 | 'New Patient' qualifications were not met. |
See the full resolution workflow for RARC M86
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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