Consultations are not allowed once treatment has been rendered by the same provider.
Code type
RARC (Remark)
Category
Non-Covered Service
Common CARC pairings
RARC N637 appears with a Claim Adjustment Reason Code (CARC) on the 835 electronic remittance advice and gives more detail about the adjustment. These are the CARCs most often paired with RARC N637.
| 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. |
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| B14 | Only one visit or consultation per physician per day is covered. |
See the full resolution workflow for RARC N637
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 requirements.
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