Exceeds number/frequency approved /allowed within time period without support documentation.
Code type
RARC (Remark)
Category
Non-Covered Service
Common CARC pairings
RARC N435 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 N435.
| 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. |
| 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. |
| 198 | Precertification/notification/authorization/pre-treatment exceeded. |
| 273 | Coverage/program guidelines were exceeded. |
| P31 | Payment denied for exacerbation when treatment exceeds time allowed. To be used for Property and Casualty only. |
See the full resolution workflow for RARC N435
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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