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Industry News

Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update


Wednesday, January 06, 2010

The following updates for the Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) take effect January 1, 2010.

New Codes – CARC

Code Current Narrative Effective Date Per WPC Posting
232 Institutional transfer amount. Note: Applies to Institutional claims only and explains the DRG amount differences when patients care crosses multiple institutions. 11/1/2009


Modified Codes - CARC

Code Current Narrative Effective Date Per WPC Posting
4 The procedure code is inconsistent with the modifier used or a required modifier is missing. 7/1/2010
5 The procedure code/bill type is inconsistent with the place of service. 7/1/2010
6 The procedure/revenue code is inconsistent with the patient's age. 7/1/2010
7 The procedure/revenue code is inconsistent with the patient's gender. 7/1/2010
8 The procedure code is inconsistent with the provider type/specialty (taxonomy). 7/1/2010
9 The diagnosis is inconsistent with the patient's age. 7/1/2010
10 The diagnosis is inconsistent with the patient's gender. 7/1/2010
11 The diagnosis is inconsistent with the procedure. 7/1/2010
12 The diagnosis is inconsistent with the provider type. 7/1/2010
51 These are non-covered services because this is a pre-existing condition. 7/1/2010
96 Non-covered charge(s). 7/1/2010
97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. 7/1/2010
107 Related or qualifying claim/service was not identified on the claim. 7/1/2010
167 This (these) diagnosis(es) is (are) not covered. 7/1/2010
170 Payment is denied when performed/billed by this type of provider. 7/1/2010
171 Payment is denied when performed/billed by this type of provider in this type of facility. 7/1/2010
172 Payment is adjusted when performed/billed by a provider of this specialty. 7/1/2010
179 Patient has not met the required waiting requirements. 7/1/2010
183 The referring provider is not eligible to refer the service billed. 7/1/2010
184 The prescribing/ordering provider is not eligible to prescribe/order the service billed. 7/1/2010
185 The rendering provider is not eligible to perform the service billed. 7/1/2010
222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. 7/1/2010
B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. 7/1/2010
B8 Alternative services were available, and should have been utilized. 7/1/2010
B15 This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. 7/1/2010
16 Claim/service lacks information which is needed for adjudication. 7/1/2010
125 Submission/billing error(s). 7/1/2010
148 Information from another provider was not provided or was insufficient/incomplete. 7/1/2010
226 Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. 7/1/2010
227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. 7/1/2010
A1 Claim/Service denied. 7/1/2010
40 Charges do not meet qualifications for emergent/urgent care. This change to be effective 07/01/2010: Charges do not meet qualifications for emergent/urgent care. 7/1/2010


Deactivated Codes – CARC

Code Current Narrative Effective Date
87 Transfer Amount 1/1/2012


New Codes – RARC

Code Current Narrative Medicare Initiated
N521 Mismatch between the submitted provider information and the provider information stored in our system. NO
N522 Duplicate of a claim processed as a crossover claim. NO


Modified Codes – RARC

Code Modified Narrative Medicare Initiated
M39 The patient is not liable for payment for this service as the advance notice of non-coverage you provided the patient did not comply with program requirements. NO
M118 Letter to follow containing further information. NO
N59 Please refer to your provider manual for additional program and provider information. NO
N130 Consult plan benefit documents/guidelines for information about restrictions for this service. NO
N202 Additional information/explanation will be sent separately. NO


CMS

Additional Information: Source


Wednesday, January 06, 2010