Determination based on the provisions of the insurance policy.
Code type
RARC (Remark)
Category
P&C Guidelines
Common CARC pairings
RARCs like N580 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC N580 is most often paired with.
| CARC | Meaning |
|---|---|
| P21 | Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only. |
See the full resolution workflow for RARC N580
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