BILLING NEWS

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

Below are the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective October 1, 2010 for Medicare.
New Codes – RARC


Code

Current Narrative

Medicare Initiated

N534

This is an individual policy, the employer does not participate in plan sponsorship.

NO

N535

Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.

YES

N536

We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us.

NO

N537

We have examined claims history and no records of the services have been found.

NO

N538

A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.

NO

N539

Alert: We processed appeals/waiver requests on your behalf and that request has been denied.

NO

Modified Codes – RARC


Code  

Modified Narrative       

Medicare Initiated


N104

This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov.

YES

N115

This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.

YES

N386

This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.

YES

N528

Patient is entitled to benefits for Institutional Services only.

NO

N529

Patient is entitled to benefits for Professional Services only.

NO

N530

Not Qualified for Recovery based on enrollment information.

NO

Deactivated Codes – RARC


Code   

Current Narrative       

Note


M118

Letter to follow containing further information.

Consider using N202

MA101

A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.

Consider using N538

N514

Consult plan benefit documents/guidelines for information about restrictions for this service.

Consider using N130


SOURCE: Source:
INDUSTRY NEWS TAGS: CMS


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