BILLING NEWS
Remittance Advice Remark Code and Claim Adjustment Reason Code for Dec. 2008
The following changes to the RARC and CARC codes will be effective January 1, 2009:
Remittance Advice Remark Code Changes
| Code | Current Narrative | Medicare Initiated |
| N435 | Exceeds number/frequency approved /allowed within time period without support documentation. Start: 7/1/2008 | |
| N436 | The injury claim has not been accepted and a mandatory medical reimbursement has been made. Start: 7/1/2008 | |
| N437 | Alert: If the injury claim is accepted, these charges will be reconsidered. Start: 7/1/2008 | |
| N438 | This jurisdiction only accepts paper claims. Start: 7/1/2008 | |
| N442 | Payment based on an alternate fee schedule. Start: 7/1/2008 | |
| N445 | Missing document for actual cost or paid amount. Start: 7/1/2008 | |
| N446 | Incomplete/invalid document for actual cost or paid amount. Start: 7/1/2008 | |
| N447 | Payment is based on a generic equivalent as required documentation was not provided. Start: 7/1/2008 | |
| N448 | This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement. Start: 7/1/2008 | |
| N449 | Payment based on a comparable drug/service/supply. Start: 7/1/2008 | |
| N453 | Missing Consultation Report. Start: 7/1/2008 | |
| N454 | Incomplete/invalid Consultation Report. Start: 7/1/2008 | |
| N455 | Missing Physician Order. Start: 7/1/2008 | |
| N456 | Incomplete/invalid Physician Order. Start: 7/1/2008 | |
| N457 | Missing Diagnostic Report. Start: 7/1/2008 | |
| N458 | Incomplete/invalid Diagnostic Report. Start: 7/1/2008 | |
| N463 | Missing support data for claim. Start: 7/1/2008 | |
| N464 | Incomplete/invalid support data for claim. Start: 7/1/2008 | |
| N467 | Missing Report of Tests and Analysis Report. Start: 7/1/2008 | |
| N468 | Incomplete/invalid Report of Tests and Analysis Report. Start: 7/1/2008 | |
| N469 | Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Start: 7/1/2008 | YES |
| N470 | This payment will complete the mandatory medical reimbursement limit. Start: 7/1/2008 | |
| N471 | Missing/incomplete/invalid HIPPS Rate Code. Start: 7/1/2008 | |
| N472 | Payment for this service has been issued to another provider. Start: 7/1/2008 | |
| N473 | Missing certification. Start: 7/1/2008 | |
| N474 | Incomplete/invalid certification Start: Start: 7/1/2008 | |
| N475 | Missing completed referral form. Start: 7/1/2008 | |
| N476 | Incomplete/invalid completed referral form Start: 7/1/2008 | |
| N479 | Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer). Start: 7/1/2008 | |
| N480 | Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer). Start: 7/1/2008 | |
| N489 | Missing referral form. Start: 7/1/2008 | |
| N490 | Incomplete/invalid referral form Start: 7/1/2008 | |
| N492 | Alert: A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge. Start: 7/1/2008 | |
| N493 | Missing Doctor First Report of Injury. Start: 7/1/2008 | |
| N494 | Incomplete/invalid Doctor First Report of Injury. Start: 7/1/2008 | |
| N495 | Missing Supplemental Medical Report. Start: 7/1/2008 | |
| N496 | Incomplete/invalid Supplemental Medical Report. Start: 7/1/2008 | |
| N497 | Missing Medical Permanent Impairment or Disability Report. Start: 7/1/2008 | |
| N498 | Incomplete/invalid Medical Permanent Impairment or Disability Report. Start: 7/1/2008 | |
| N499 | Missing Medical Legal Report. Start: 7/1/2008 | |
| N500 | Incomplete/invalid Medical Legal Report. Start: 7/1/2008 | |
| N501 | Missing Vocational Report. Start: 7/1/2008 | |
| N502 | Incomplete/invalid Vocational Report. Start: 7/1/2008 | |
| N503 | Missing Work Status Report. Start: 7/1/2008 | |
| N504 | Incomplete/invalid Work Status Report. Start: 7/1/2008 |
Modified Codes
| Code | Current Modified Narrative | Last Modified |
| N10 | Payment based on the findings of a review organization/professional consult/manual adjudication/medical or dental advisor. | 7/1/08 |
| N26 | Missing itemized bill/statement. | 7/1/08 |
| N130 | Alert: Consult plan benefit documents/guidelines for information about restrictions for this service. | 7/1/08 |
| N209 | Missing/incomplete/invalid taxpayer identification number (TIN). | 7/1/08 |
| N232 | Incomplete/invalid itemized bill/statement. | 7/1/08 |
| N350 | Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure. | 7/1/08 |
| N390 | This service/report cannot be billed separately | 7/1/08 |
| N393 | Missing progress notes/report | 7/1/08 |
| N394 | Incomplete/invalid progress notes/report. | 7/1/08 |
Care Claim Adjustment Reason Codes
| Code | Current Narrative | Implementation Date |
| 222 | Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Start Date: 6/1/2008 | 1/5/2009 |
| 223 | Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. Start Date: 6/1/2008 | 1/5/2009 |
| 224 | Patient identification compromised by identity theft. Identity verification required for processing this and future claims. Start Date: 6/1/2008 | 1/5/2009 |
| 225 | Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837) Start Date: 6/1/2008 | 1/5/2009 |
Modified Codes
| Code | Current Narrative | Implementation Date |
| 60 | Charges for outpatient services with this proximity to inpatient services are not covered. This change to be effective 1/1/2009: Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services. |
1/5/2009 |
Deactivated Codes
| Code | Modified Narrative | Implementation Date |
| D22 | Reimbursement was adjusted for the reasons to be provided in separate correspondence. (Note: To be used for Workers' Compensation only) - Temporary code to be added for timeframe only until 01/01/2009. Another code to be established and/or for 06/2008 meeting for a revised code to replace or strategy to use another existing code. Start: 01/27/2008 | Stop: 01/01/2009 | 1/1/2009 |
SOURCE: Source
