Referral not authorized by attending physician).
Code type
RARC (Remark)
Category
Plan Provision
Common CARC pairings
RARCs like N630 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC N630 is most often paired with.
| CARC | Meaning |
|---|---|
| 95 | Plan procedures not followed. |
| 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. |
| 183 | The referring provider is not eligible to refer the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 243 | Services not authorized by network/primary care providers. |
See the full resolution workflow for RARC N630
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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