Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
Code type
RARC (Remark)
Category
Non-Covered Service
Common CARC pairings
RARCs like N623 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC N623 is most often paired with.
| CARC | Meaning |
|---|---|
| 55 | Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 56 | Procedure/treatment has not been deemed 'proven to be effective' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 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. |
| 114 | Procedure/product not approved by the Food and Drug Administration. |
| 256 | Service not payable per managed care contract. |
See the full resolution workflow for RARC N623
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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