CR 6901 announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective July 1, 2010.
New Codes - CARC|
Code |
|
Effective Date Per WPC Posting |
233 |
Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. |
1/24/2010 |
234 |
This procedure is not paid separately. 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.) |
1/24/2010 |
New Codes - RARC
Code |
|
Medicare Initiated |
N523 |
The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid. |
YES |
N524 |
Based on policy this payment constitutes payment in full. |
NO |
N525 |
These services are not covered when performed within the global period of another service. |
NO |
N526 |
Not qualified for recovery based on employer size. |
YES |
N527 |
We processed this claim as the primary payer prior to receiving the recovery demand. |
YES |
N528 |
Patient is entitled to benefits for Institutional Services. |
YES |
N529 |
Patient is entitled to benefits for Professional Services. |
YES |
N530 |
Our records indicate a mismatch in enrollment information for this patient. |
YES |
N531 |
Not qualified for recovery based on direct payment of premium. |
YES |
N532 |
Not qualified for recovery based on disability and working status. |
YES |
Modified Codes – RARC:
Code |
|
Medicare Initiated |
N216 |
We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package |
NO |
N522 |
Duplicate of a claim processed, or to be processed, as a crossover claim. |
NO |
