No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
Code type
RARC (Remark)
Category
Duplicate
Common CARC pairings
RARC N111 appears with a Claim Adjustment Reason Code (CARC) on the 835 electronic remittance advice and gives more detail about the adjustment. These are the CARCs most often paired with RARC N111.
| CARC | Meaning |
|---|---|
| 18 | Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO) |
| 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. |
| 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. |
| 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. |
See the full resolution workflow for RARC N111
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 requirements.
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