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- Remittance Advice Remark and Claims Adjustment Reason Code update October 1, 2013
Remittance Advice Remark and Claims Adjustment Reason Code update October 1, 2013
September 24, 2013For transaction 835 (Health Care Claim Payment/Advice) and standard paper remittance advice, valid Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) must be used to report payment adjustments, appeal rights, and related information.
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New – CARC: |
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Code |
Narrative |
Effective Date |
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253 |
Sequestration – reduction in federal spending |
6/2/2013 |
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254 |
Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient’s medical plan for further consideration. |
6/2/2013 |
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255 |
The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. (Use only with Group Code OA) |
6/2/2013 |
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256 |
Service not payable per managed care contract. |
6/2/2013 |
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W5 |
Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. (Use with Group Code CO or OA) |
6/2/2013 |
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W6 |
Referral not authorized by attending physician per regulatory requirement. |
6/2/2013 |
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W7 |
Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service. |
6/2/2013 |
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W8 |
Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. |
6/2/2013 |
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W9 |
Service not paid under jurisdiction allowed outpatient facility fee schedule. |
6/2/2013 |
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New – RARC: (summary of some new codes; list has extensive additions) |
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Code |
Narrative |
Effective Date |
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N574 |
Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider. |
7/15/2013 |
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N575 |
Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records. |
7/15/2013 |
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N598 |
Health care policy coverage is primary. |
7/15/2013 |
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N600 |
Adjusted based on the applicable fee schedule for the region in which the service was rendered. |
7/15/2013 |
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N613 |
Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future. |
7/15/2013 |
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N622 |
Not covered based on the date of injury/accident. |
7/15/2013 |
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N623 |
Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate. |
7/15/2013 |