Not covered based on the date of injury/accident.
Code type
RARC (Remark)
Category
Patient Eligibility
Common CARC pairings
RARCs like N622 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC N622 is most often paired with.
| CARC | Meaning |
|---|---|
| 26 | Expenses incurred prior to coverage. |
| 27 | Expenses incurred after coverage terminated. |
| 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. |
| 110 | Billing date predates service date. |
| 160 | Injury/illness was the result of an activity that is a benefit exclusion. |
| 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 N622
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.
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