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
INDUSTRY NEWS TAGS: CMS


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