A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
Code type
RARC (Remark)
Category
Non-Covered Service
Common CARC pairings
RARCs like N538 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC N538 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. |
| 109 | Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor. |
| 190 | Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. |
| B20 | Procedure/service was partially or fully furnished by another provider. |
See the full resolution workflow for RARC N538
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