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.
Code type
RARC (Remark)
Category
Non-Covered Service
Common CARC pairings
RARCs like N12 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC N12 is most often paired with.
| CARC | Meaning |
|---|---|
| 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. |
| 204 | This service/equipment/drug is not covered under the patient's current benefit plan. |
See the full resolution workflow for RARC N12
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.
Open in EDI Lab