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

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



Current Narrative

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


Current Narrative

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


Modified Narrative

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


 


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INDUSTRY NEWS TAGS: CMS


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