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Denial Codes Lookup: CARC & RARC

Search every CARC and RARC code in one place. Type a code (e.g., 16, CO-45, N130) or a keyword to find what a denial means.

What these codes are

CARC (Claim Adjustment Reason Codes) tell you why a payer adjusted or denied a claim line. RARC (Remittance Advice Remark Codes) add supporting detail. They appear together on the EOB / ERA a payer returns after adjudicating a claim.

Reference only. CARC/RARC are national code sets updated periodically — verify against the current official list before acting on a denial.

1
Deductible Amount
CARC
2
Coinsurance Amount
CARC
3
Co-payment Amount
CARC
4
The procedure code is inconsistent with the modifier used
CARC
5
The procedure code/type of bill is inconsistent with the place of service
CARC
6
The procedure/revenue code is inconsistent with the patient's age
CARC
7
The procedure/revenue code is inconsistent with the patient's gender
CARC
8
The procedure code is inconsistent with the provider type/specialty
CARC
9
The diagnosis is inconsistent with the patient's age
CARC
10
The diagnosis is inconsistent with the patient's gender
CARC
11
The diagnosis is inconsistent with the procedure
CARC
12
The diagnosis is inconsistent with the provider type
CARC
13
The date of death precedes the date of service
CARC
14
The date of birth follows the date of service
CARC
16
Claim/service lacks information or has submission/billing error(s)
CARC
18
Exact duplicate claim/service
CARC
19
This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier
CARC
20
This injury/illness is covered by the liability carrier
CARC
21
This injury/illness is the liability of the no-fault carrier
CARC
22
This care may be covered by another payer per coordination of benefits
CARC
23
The impact of prior payer(s) adjudication including payments and/or adjustments
CARC
24
Charges are covered under a capitation agreement/managed care plan
CARC
26
Expenses incurred prior to coverage
CARC
27
Expenses incurred after coverage terminated
CARC
29
The time limit for filing has expired
CARC
31
Patient cannot be identified as our insured
CARC
32
Our records indicate the patient is not an eligible dependent
CARC
33
Insured has no dependent coverage
CARC
34
Insured has no coverage for newborns
CARC
35
Lifetime benefit maximum has been reached
CARC
39
Services denied at the time authorization/pre-certification was requested
CARC
40
Charges do not meet qualifications for emergent/urgent care
CARC
44
Prompt-pay discount
CARC
45
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement
CARC
49
This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam
CARC
50
These are non-covered services because this is not deemed a 'medical necessity' by the payer
CARC
51
These are non-covered services because this is a pre-existing condition
CARC
53
Services by an immediate relative or a member of the same household are not covered
CARC
54
Multiple physicians/assistants are not covered in this case
CARC
55
Procedure/treatment/drug is deemed experimental/investigational by the payer
CARC
56
Procedure/treatment has not been deemed 'proven to be effective' by the payer
CARC
58
Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service
CARC
59
Processed based on multiple or concurrent procedure rules
CARC
60
Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services
CARC
61
Adjusted for failure to obtain second surgical opinion
CARC
66
Blood Deductible
CARC
69
Day outlier amount
CARC
70
Cost outlier - Adjustment to compensate for additional costs
CARC
74
Indirect Medical Education Adjustment
CARC
75
Direct Medical Education Adjustment
CARC
76
Disproportionate Share Adjustment
CARC
78
Non-Covered days/Room charge adjustment
CARC
85
Patient Interest Adjustment
CARC
89
Professional fees removed from charges
CARC
90
Ingredient cost adjustment
CARC
91
Dispensing fee adjustment
CARC
94
Processed in Excess of charges
CARC
95
Plan procedures not followed
CARC
96
Non-covered charge(s). Remark code required
CARC
97
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated
CARC
100
Payment made to patient/insured
CARC
101
Predetermination: anticipated payment upon completion of services or claim adjudication
CARC
102
Major Medical Adjustment
CARC
103
Provider promotional discount
CARC
104
Managed care withholding
CARC
105
Tax withholding
CARC
106
Patient payment option/election not in effect
CARC
107
The related or qualifying claim/service was not identified on this claim
CARC
108
Rent/purchase guidelines were not met
CARC
109
Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor
CARC
110
Billing date predates service date
CARC
111
Not covered unless the provider accepts assignment
CARC
112
Service not furnished directly to the patient and/or not documented
CARC
114
Procedure/product not approved by the Food and Drug Administration
CARC
115
Procedure postponed, canceled, or delayed
CARC
116
The advance indemnification notice signed by the patient did not comply with requirements
CARC
117
Transportation is only covered to the closest facility that can provide the necessary care
CARC
118
ESRD network support adjustment
CARC
119
Benefit maximum for this time period or occurrence has been reached
CARC
121
Indemnification adjustment - compensation for outstanding member responsibility
CARC
122
Psychiatric reduction
CARC
128
Newborn's services are covered in the mother's Allowance
CARC
129
Prior processing information appears incorrect. Remark code required
CARC
130
Claim submission fee
CARC
131
Claim specific negotiated discount
CARC
132
Prearranged demonstration project adjustment
CARC
133
The disposition of this service line is pending further review
CARC
134
Technical fees removed from charges
CARC
135
Interim bills cannot be processed
CARC
136
Failure to follow prior payer's coverage rules
CARC
137
Regulatory Surcharges, Assessments, Allowances or Health Related Taxes
CARC
139
Contracted funding agreement - Subscriber is employed by the provider of services. Use only with Group Code CO
CARC
140
Patient/Insured health identification number and name do not match
CARC
142
Monthly Medicaid patient liability amount
CARC
143
Portion of payment deferred
CARC
144
Incentive adjustment, e.g. preferred product/service
CARC
146
Diagnosis was invalid for the date(s) of service reported
CARC
147
Provider contracted/negotiated rate expired or not on file
CARC
148
Information from another provider was missing/incomplete. Remark code required
CARC
149
Lifetime benefit maximum has been reached for this service/benefit category
CARC
150
Payer deems the information submitted does not support this level of service
CARC
151
Payment adjusted because the payer deems the information submitted does not support this many/frequency of services
CARC
152
Payer deems the information submitted does not support this length of service
CARC
153
Payer deems the information submitted does not support this dosage
CARC
154
Payer deems the information submitted does not support this day's supply
CARC
155
Patient refused the service/procedure
CARC
157
Service/procedure was provided as a result of an act of war
CARC
158
Service/procedure was provided outside of the United States
CARC
159
Service/procedure was provided as a result of terrorism
CARC
160
Injury/illness was the result of an activity that is a benefit exclusion
CARC
161
Provider performance bonus
CARC
163
Attachment/other documentation referenced on the claim was not received
CARC
164
Attachment/other documentation referenced on the claim was not received in a timely fashion
CARC
166
These services were submitted after this payers responsibility for processing claims under this plan ended
CARC
167
This diagnosis(es) is not covered
CARC
169
Alternate benefit has been provided
CARC
170
Payment is denied when performed/billed by this type of provider
CARC
171
Payment is denied when performed/billed by this type of provider in this type of facility
CARC
172
Payment is adjusted when performed/billed by a provider of this specialty
CARC
173
Service/equipment was not prescribed by a physician
CARC
174
Service was not prescribed prior to delivery
CARC
175
Prescription is incomplete
CARC
176
Prescription is not current
CARC
177
Patient has not met the required eligibility requirements
CARC
178
Patient has not met the required spend down requirements
CARC
179
Patient has not met the required waiting requirements
CARC
180
Patient has not met the required residency requirements
CARC
181
Procedure code was invalid on the date of service
CARC
182
Procedure modifier was invalid on the date of service
CARC
183
The referring provider is not eligible to refer the service billed
CARC
184
The ordering provider is not eligible to prescribe/order the service billed
CARC
185
The rendering provider is not eligible to perform the service billed
CARC
186
Level of care change adjustment
CARC
187
Consumer Spending Account payments
CARC
188
This product/procedure is only covered when used according to FDA recommendations
CARC
189
'Not otherwise classified' or 'unlisted' procedure code was billed when there is a specific procedure code for this procedure/service
CARC
190
Payment is included in the allowance for a Skilled Nursing Facility qualified stay
CARC
192
Non standard adjustment code from paper remittance
CARC
193
Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly
CARC
194
Anesthesia performed by the operating physician, the assistant surgeon or the attending physician
CARC
195
Refund issued to an erroneous priority payer for this claim/service
CARC
197
preauth/notification absent
CARC
198
preauth/notification exceeded
CARC
199
Revenue code and Procedure code do not match
CARC
200
Expenses incurred during lapse in coverage
CARC
201
Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. Remark code required
CARC
202
Non-covered personal comfort or convenience services
CARC
203
Discontinued or reduced service
CARC
204
This service/equipment/drug is not covered under the patient's current benefit plan
CARC
205
Pharmacy discount card processing fee
CARC
206
NPI - missing
CARC
207
NPI - Invalid format
CARC
208
NPI - Not matched
CARC
209
Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected
CARC
210
Payment adjusted because pre-certification/authorization not received in a timely fashion
CARC
211
National Drug Codes not eligible for rebate, are not covered
CARC
212
Administrative surcharges are not covered
CARC
213
Non-compliance with the physician self referral prohibition legislation or payer policy
CARC
215
Based on subrogation of a third party settlement
CARC
216
Based on the findings of a review organization or the payer's findings
CARC
219
Based on extent of injury
CARC
222
Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific
CARC
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
CARC
224
Patient identification compromised by identity theft. Identity verification required for processing this and future claims
CARC
225
Penalty or Interest Payment by Payer
CARC
226
Information requested from the billing/rendering provider missing/incomplete or late. Remark code required
CARC
227
Information requested from the patient/insured was missing/incomplete. Remark code required
CARC
228
Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication
CARC
229
Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X
CARC
231
Mutually exclusive procedures cannot be done in the same day/setting
CARC
232
Institutional Transfer Amount
CARC
233
Services/charges related to the treatment of a hospital-acquired condition or preventable medical error
CARC
234
This procedure is not paid separately. Remark code required
CARC
235
Sales Tax
CARC
236
This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Corr…
CARC
237
Legislated/Regulatory Penalty. Remark code required
CARC
238
Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period
CARC
239
Claim spans eligible and ineligible periods of coverage. Rebill separate claims
CARC
240
The diagnosis is inconsistent with the patient's birth weight
CARC
241
Low Income Subsidy Co-payment Amount
CARC
242
Services not provided by network/primary care providers
CARC
243
Services not authorized by network/primary care providers
CARC
245
Provider performance program withhold
CARC
246
This non-payable code is for required reporting only
CARC
247
Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim
CARC
248
Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim
CARC
249
This claim has been identified as a readmission
CARC
250
The attachment/other documentation that was received was the incorrect attachment/document. The expected attachment/document is still missing. Remark code required
CARC
251
The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. Remark code required
CARC
252
An attachment/other documentation is required to adjudicate this claim/service. Remark code required
CARC
253
Sequestration - reduction in federal payment
CARC
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
CARC
256
Service not payable per managed care contract
CARC
257
The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. This claim/service will be reversed and c…
CARC
258
Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service
CARC
259
Additional payment for Dental/Vision service utilization
CARC
260
Processed under Medicaid ACA Enhanced Fee Schedule
CARC
261
The procedure or service is inconsistent with the patient's history
CARC
262
Adjustment for delivery cost
CARC
263
Adjustment for shipping cost
CARC
264
Adjustment for postage cost
CARC
265
Adjustment for administrative cost
CARC
266
Adjustment for compound preparation cost
CARC
267
Claim/service spans multiple months. Remark code required
CARC
268
The Claim spans two calendar years. Please resubmit one claim per calendar year
CARC
269
Anesthesia not covered for this service/procedure
CARC
270
Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's dental plan for further consideration
CARC
271
Prior contractual reductions related to a current periodic payment as part of a contractual payment schedule when deferred amounts have been previously reported
CARC
272
Coverage/program guidelines were not met
CARC
273
Coverage/program guidelines were exceeded
CARC
274
Fee/Service not payable per patient Care Coordination arrangement
CARC
275
Prior payer's patient responsibility not covered
CARC
276
Services denied by the prior payer(s) are not covered by this payer
CARC
277
The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. This claim/service will be reversed…
CARC
278
Performance program proficiency requirements not met
CARC
279
Services not provided by Preferred network providers
CARC
280
Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's Pharmacy plan for further consideration
CARC
281
Deductible waived per contractual agreement. Use only with Group Code CO
CARC
282
The procedure/revenue code is inconsistent with the type of bill
CARC
283
Attending provider is not eligible to provide direction of care
CARC
284
preauth/notification number may be valid but does not apply to the billed services
CARC
285
Appeal procedures not followed
CARC
286
Appeal time limits not met
CARC
287
Referral exceeded
CARC
288
Referral absent
CARC
289
Services considered under the dental and medical plans, benefits not available
CARC
290
Claim received by the dental plan, but benefits not available under this plan. Claim has been forwarded to the patient's medical plan for further consideration
CARC
291
Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's dental plan for further consideration
CARC
292
Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's pharmacy plan for further consideration
CARC
293
Payment made to employer
CARC
294
Payment made to attorney
CARC
295
Pharmacy Direct/Indirect Remuneration
CARC
296
preauth/notification number may be valid but does not apply to the provider
CARC
297
Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's vision plan for further consideration
CARC
298
Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's vision plan for further consideration
CARC
299
The billing provider is not eligible to receive payment for the service billed
CARC
300
Claim received by the Medical Plan, but benefits not available under this plan. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration
CARC
301
Claim received by the Medical Plan, but benefits not available under this plan. Submit these services to the patient's Behavioral Health Plan for further consideration
CARC
302
preauth/notification time limit has expired
CARC
303
Prior payer's patient responsibility not covered for Qualified Medicare and Medicaid Beneficiaries
CARC
304
Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's hearing plan for further consideration
CARC
305
Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's hearing plan for further consideration
CARC
306
Type of bill is inconsistent with the patient status
CARC
307
Medicare Maximum Fair Price Standard Default Refund Amount Adjustment. Remark code required
CARC
308
Payment is adjusted due to contracted funding agreement between the payer and provider
CARC
A0
Patient refund amount
CARC
A1
Claim/Service denied. Remark code required
CARC
A5
Medicare Claim PPS Capital Cost Outlier Amount
CARC
A6
Prior hospitalization or 30 day transfer requirement not met
CARC
A8
Ungroupable DRG
CARC
B1
Non-covered visits
CARC
B4
Late filing penalty
CARC
B7
This provider was not certified/eligible to be paid for this procedure/service on this date of service
CARC
B8
Alternative services were available, and should have been utilized
CARC
B9
Patient is enrolled in a Hospice
CARC
B10
Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test
CARC
B11
The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor
CARC
B12
Services not documented in patient's medical records
CARC
B13
Previously paid. Payment for this claim/service may have been provided in a previous payment
CARC
B14
Only one visit or consultation per physician per day is covered
CARC
B15
This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated
CARC
B16
'New Patient' qualifications were not met
CARC
B20
Procedure/service was partially or fully furnished by another provider
CARC
B22
This payment is adjusted based on the diagnosis
CARC
B23
Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment proficiency test
CARC
P1
State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. To be used for Property and Casualty only
CARC
P2
Not a work related injury/illness and thus not the liability of the workers' compensation carrier
CARC
P3
Workers' Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. To be used for Workers'…
CARC
P4
Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment
CARC
P5
Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. To be used for Property and Casualty only
CARC
P6
Based on entitlement to benefits
CARC
P7
The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the ser…
CARC
P8
Claim is under investigation
CARC
P9
No available or correlating CPT/HCPCS code to describe this service. To be used for Property and Casualty only
CARC
P10
Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To be used for Property and Casualty only
CARC
P11
The disposition of the related Property & Casualty claim is pending due to litigation. To be used for Property and Casualty only
CARC
P12
Workers' compensation jurisdictional fee schedule adjustment
CARC
P13
Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable
CARC
P14
The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day
CARC
P15
Workers' Compensation Medical Treatment Guideline Adjustment. To be used for Workers' Compensation only
CARC
P16
Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers' Compensation only
CARC
P17
Referral not authorized by attending physician per regulatory requirement. To be used for Property and Casualty only
CARC
P18
Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service. To be used for Property and Casualty only
CARC
P19
Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. To be used for Property and Casualty only
CARC
P20
Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only
CARC
P21
Payment denied based on the Medical Payments Coverage and/or Personal Injury Protection Benefits jurisdictional regulations, or payment policies
CARC
P22
Payment adjusted based on the Medical Payments Coverage and/or Personal Injury Protection Benefits jurisdictional regulations, or payment policies
CARC
P23
Medical Payments Coverage or Personal Injury Protection Benefits jurisdictional fee schedule adjustment
CARC
P24
Payment adjusted based on Preferred Provider Organization
CARC
P25
Payment adjusted based on Medical Provider Network
CARC
P26
Payment adjusted based on Voluntary Provider network
CARC
P27
Payment denied based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies
CARC
P28
Payment adjusted based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies
CARC
P29
Liability Benefits jurisdictional fee schedule adjustment
CARC
P30
Payment denied for exacerbation when supporting documentation was not complete. To be used for Property and Casualty only
CARC
P31
Payment denied for exacerbation when treatment exceeds time allowed. To be used for Property and Casualty only
CARC
P32
Payment adjusted due to Apportionment
CARC
M1
X-ray not taken within the past 12 months or near enough to the start of treatment
RARC (M)
M2
Not paid separately when the patient is an inpatient
RARC (M)
M3
Equipment is the same or similar to equipment already being used
RARC (M)
M4
This is the last monthly installment payment for this durable medical equipment
RARC (M)
M5
Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed
RARC (M)
M6
You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment
RARC (M)
M7
No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price
RARC (M)
M8
We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen
RARC (M)
M9
This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement
RARC (M)
M10
Equipment purchases are limited to the first or the tenth month of medical necessity
RARC (M)
M11
DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code
RARC (M)
M12
Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim
RARC (M)
M13
Only one initial visit is covered per specialty per medical group
RARC (M)
M14
No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection
RARC (M)
M15
Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed
RARC (M)
M16
Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision
RARC (M)
M17
Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will…
RARC (M)
M18
Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility is considered to be a patient's home
RARC (M)
M19
Missing oxygen certification/re-certification
RARC (M)
M20
Missing/invalid HCPCS
RARC (M)
M21
Missing/invalid place of residence for this service/item provided in a home
RARC (M)
M22
Missing/invalid number of miles traveled
RARC (M)
M23
Missing invoice
RARC (M)
M24
Missing/invalid number of doses per vial
RARC (M)
M25
Coverage not supported for this level of service. Review/appeal may be requested within 120 days; patient refund/overpayment rules may apply.
RARC (M)
M26
The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service/any amount that exc…
RARC (M)
M27
Coverage not supported for this level of service. Review/appeal may be requested within 120 days; patient refund/overpayment rules may apply.
RARC (M)
M28
This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available
RARC (M)
M29
Missing operative note/report
RARC (M)
M30
Missing pathology report
RARC (M)
M31
Missing radiology report
RARC (M)
M32
Conditional payment pending primary payer decision. Refund may be required if another payer later pays this service.
RARC (M)
M36
This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase
RARC (M)
M37
Not covered when the patient is under age 35
RARC (M)
M38
Patient liable because written notice was given before service and patient agreed to be responsible.
RARC (M)
M39
The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements
RARC (M)
M40
Claim must be assigned and must be filed by the practitioner's employer
RARC (M)
M41
We do not pay for this as the patient has no legal obligation to pay for this
RARC (M)
M42
The medical necessity form must be personally signed by the attending physician
RARC (M)
M44
Missing/invalid condition code
RARC (M)
M45
Missing/invalid occurrence code(s)
RARC (M)
M46
Missing/invalid occurrence span code(s)
RARC (M)
M47
Missing/invalid Payer Claim Control Number. Also called Internal Control Number, Claim Control Number, Document Control Number
RARC (M)
M49
Missing/invalid value code(s) or amount(s)
RARC (M)
M50
Missing/invalid revenue code(s)
RARC (M)
M51
Missing/invalid procedure code(s)
RARC (M)
M52
Missing/invalid 'from' date(s) of service
RARC (M)
M53
Missing/invalid days or units of service
RARC (M)
M54
Missing/invalid total charges
RARC (M)
M55
We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug
RARC (M)
M56
Missing/invalid payer identifier
RARC (M)
M59
Missing/invalid 'to' date(s) of service
RARC (M)
M60
Missing Certificate of Medical Necessity
RARC (M)
M61
We cannot pay for this as the approval period for the FDA clinical trial has expired
RARC (M)
M62
Missing/invalid treatment authorization code
RARC (M)
M64
Missing/invalid other diagnosis
RARC (M)
M65
One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician
RARC (M)
M66
Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component…
RARC (M)
M67
Missing/invalid other procedure code(s)
RARC (M)
M69
Paid at the regular rate as you did not submit documentation to justify the modified procedure code
RARC (M)
M70
The NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item
RARC (M)
M71
Total payment reduced due to overlap of tests billed
RARC (M)
M73
The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components
RARC (M)
M74
This service does not qualify for a HPSA/Physician Scarcity bonus payment
RARC (M)
M75
Multiple automated multichannel tests performed on the same day combined for payment
RARC (M)
M76
Missing/invalid diagnosis or condition
RARC (M)
M77
Missing/invalid/inappropriate place of service
RARC (M)
M79
Missing/invalid charge
RARC (M)
M80
Not covered when performed during the same session/date as a previously processed service for the patient
RARC (M)
M81
You are required to code to the highest level of specificity
RARC (M)
M82
Service is not covered when patient is under age 50
RARC (M)
M83
Service is not covered unless the patient is classified as at high risk
RARC (M)
M84
Medical code sets used must be the codes in effect at the time of service
RARC (M)
M85
Subjected to review of physician evaluation and management services
RARC (M)
M86
Service denied because payment already made for same/similar procedure within set time frame
RARC (M)
M87
Claim/service(s) subjected to CFO-CAP prepayment review
RARC (M)
M89
Not covered more than once under age 40
RARC (M)
M90
Not covered more than once in a 12 month period
RARC (M)
M91
Lab procedures with different CLIA certification numbers must be billed on separate claims
RARC (M)
M93
Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment
RARC (M)
M94
Information supplied does not support a break in therapy. A new capped rental period will not begin
RARC (M)
M95
Services subjected to Home Health Initiative medical review/cost report audit
RARC (M)
M96
Technical component for inpatient service can only be billed by the inpatient facility; bill only the professional component if applicable.
RARC (M)
M97
Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility
RARC (M)
M99
Missing/invalid Universal Product Number/Serial Number
RARC (M)
M100
We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug
RARC (M)
M102
Service not performed on equipment approved by the FDA for this purpose
RARC (M)
M103
Break in therapy information affected coverage/payment determination for this item.
RARC (M)
M104
Break in therapy information affected coverage/payment determination for this item.
RARC (M)
M105
Break in therapy information affected coverage/payment determination for this item.
RARC (M)
M107
Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%
RARC (M)
M109
We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner
RARC (M)
M111
We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken
RARC (M)
M112
Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides
RARC (M)
M113
Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program
RARC (M)
M114
This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these pr…
RARC (M)
M115
This item is denied when provided to this patient by a non-contract or non-demonstration supplier
RARC (M)
M116
Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program
RARC (M)
M117
Not covered unless submitted via electronic claim
RARC (M)
M119
Missing/invalid/ deactivated/withdrawn National Drug Code
RARC (M)
M121
We pay for this service only when performed with a covered cryosurgical ablation
RARC (M)
M122
Missing/invalid level of subluxation
RARC (M)
M123
Missing/invalid name, strength, or dosage of the drug furnished
RARC (M)
M124
Missing indication of whether the patient owns the equipment that requires the part or supply
RARC (M)
M125
Missing/invalid information on the period of time for which the service/supply/equipment will be needed
RARC (M)
M126
Missing/invalid individual lab codes included in the test
RARC (M)
M127
Missing patient medical record for this service
RARC (M)
M129
Missing/invalid indicator of x-ray availability for review
RARC (M)
M130
Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used
RARC (M)
M131
Missing physician financial relationship form
RARC (M)
M132
Missing pacemaker registration form
RARC (M)
M133
Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test
RARC (M)
M134
Performed by a facility/supplier in which the provider has a financial interest
RARC (M)
M135
Missing/invalid plan of treatment
RARC (M)
M136
Missing/invalid indication that the service was supervised or evaluated by a physician
RARC (M)
M137
Part B coinsurance under a demonstration project or pilot program
RARC (M)
M138
Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration pa…
RARC (M)
M139
Denied services exceed the coverage limit for the demonstration
RARC (M)
M141
Missing physician certified plan of care
RARC (M)
M142
Missing American Diabetes Association Certificate of Recognition
RARC (M)
M143
The provider must update license information with the payer
RARC (M)
M144
Pre-/post-operative care payment is included in the allowance for the surgery/procedure
RARC (M)
MA01
Coverage not supported for this level of service. Review/appeal may be requested within 120 days; patient refund/overpayment rules may apply.
RARC (MA)
MA02
If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice
RARC (MA)
MA04
Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible
RARC (MA)
MA07
The claim information has also been forwarded to Medicaid for review
RARC (MA)
MA08
Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare
RARC (MA)
MA09
Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement
RARC (MA)
MA10
The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient
RARC (MA)
MA12
You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this service(s)
RARC (MA)
MA13
You may be subject to penalties if you bill the patient for amounts not reported with the PR group code
RARC (MA)
MA14
The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this…
RARC (MA)
MA15
Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported
RARC (MA)
MA16
The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703
RARC (MA)
MA17
We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment
RARC (MA)
MA18
The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them
RARC (MA)
MA19
Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondar…
RARC (MA)
MA20
Skilled Nursing Facility stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence
RARC (MA)
MA21
SSA records indicate mismatch with name and sex
RARC (MA)
MA22
Payment of less than $1.00 suppressed
RARC (MA)
MA23
Demand bill approved as result of medical review
RARC (MA)
MA24
Christian Science Sanitarium/ Skilled Nursing Facility bill in the same benefit period
RARC (MA)
MA25
A patient may not elect to change a hospice provider more than once in a benefit period
RARC (MA)
MA26
Our records indicate that you were previously informed of this rule
RARC (MA)
MA27
Missing/invalid entitlement number or name shown on the claim
RARC (MA)
MA28
Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. N…
RARC (MA)
MA30
Missing/invalid type of bill
RARC (MA)
MA31
Missing/invalid beginning and ending dates of the period billed
RARC (MA)
MA32
Missing/invalid number of covered days during the billing period
RARC (MA)
MA33
Missing/invalid non-covered days during the billing period
RARC (MA)
MA34
Missing/invalid number of coinsurance days during the billing period
RARC (MA)
MA35
Missing/invalid number of lifetime reserve days
RARC (MA)
MA36
Missing/invalid patient name
RARC (MA)
MA37
Missing/invalid patient's address
RARC (MA)
MA39
Missing/invalid gender
RARC (MA)
MA40
Missing/invalid admission date
RARC (MA)
MA41
Missing/invalid admission type
RARC (MA)
MA42
Missing/invalid admission source
RARC (MA)
MA43
Missing/invalid patient status
RARC (MA)
MA44
No appeal rights. Adjudicative decision based on law
RARC (MA)
MA45
As previously advised, a portion or all of your payment is being held in a special account
RARC (MA)
MA46
The new information was considered but additional payment will not be issued
RARC (MA)
MA47
Provider opted out of Medicare; claim not payable. Patient is responsible, subject to limiting charge rules if applicable.
RARC (MA)
MA48
Missing/invalid name or address of responsible party or primary payer
RARC (MA)
MA50
Missing/invalid Investigational Device Exemption number or Clinical Trial number
RARC (MA)
MA53
Missing/invalid Competitive Bidding Demonstration Project identification
RARC (MA)
MA54
Physician certification or election consent for hospice care not received timely
RARC (MA)
MA55
Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services
RARC (MA)
MA56
Provider opted out of Medicare; claim not payable. Patient is responsible, subject to limiting charge rules if applicable.
RARC (MA)
MA57
Patient submitted written request to revoke his/her election for religious non-medical health care services
RARC (MA)
MA58
Missing/invalid release of information indicator
RARC (MA)
MA59
Patient overpaid. Refund the overpayment within 30 days based on the patient responsibility shown on this notice.
RARC (MA)
MA60
Missing/invalid patient relationship to insured
RARC (MA)
MA61
Missing/invalid social security number
RARC (MA)
MA62
This is a telephone review decision
RARC (MA)
MA63
Missing/invalid principal diagnosis
RARC (MA)
MA64
Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers
RARC (MA)
MA65
Missing/invalid admitting diagnosis
RARC (MA)
MA66
Missing/invalid principal procedure code
RARC (MA)
MA67
Correction to a prior claim
RARC (MA)
MA68
We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to ass…
RARC (MA)
MA69
Missing/invalid remarks
RARC (MA)
MA70
Missing/invalid provider representative signature
RARC (MA)
MA71
Missing/invalid provider representative signature date
RARC (MA)
MA72
Patient overpaid. Refund the overpayment within 30 days based on the patient responsibility shown on this notice.
RARC (MA)
MA73
Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care
RARC (MA)
MA74
This payment replaces an earlier payment for this claim that was either lost, damaged or returned
RARC (MA)
MA75
Missing/invalid patient or authorized representative signature
RARC (MA)
MA76
Missing/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services
RARC (MA)
MA77
Patient overpaid. Refund the overpayment within 30 days based on the patient responsibility shown on this notice.
RARC (MA)
MA79
Billed in excess of interim rate
RARC (MA)
MA80
Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstrati…
RARC (MA)
MA81
Missing/invalid provider/supplier signature
RARC (MA)
MA83
Did not indicate whether we are the primary or secondary payer
RARC (MA)
MA84
Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved…
RARC (MA)
MA88
Missing/invalid insured's address and/or telephone number for the primary payer
RARC (MA)
MA89
Missing/invalid patient's relationship to the insured for the primary payer
RARC (MA)
MA90
Missing/invalid employment status code for the primary insured
RARC (MA)
MA91
This determination is the result of the appeal you filed
RARC (MA)
MA92
Missing plan information for other insurance
RARC (MA)
MA93
Non-PIP claim
RARC (MA)
MA94
Did not enter the statement 'Attending physician not hospice employee' on the claim form to certify that the rendering physician is not an employee of the hospice
RARC (MA)
MA96
Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan
RARC (MA)
MA97
Missing/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number
RARC (MA)
MA99
Missing/invalid Medigap information
RARC (MA)
MA100
Missing/invalid date of current illness or symptoms
RARC (MA)
MA103
Hemophilia Add On
RARC (MA)
MA106
PIP claim
RARC (MA)
MA107
Paper claim contains more than three separate data items in field 19
RARC (MA)
MA108
Paper claim contains more than one data item in field 23
RARC (MA)
MA109
Claim processed in accordance with ambulatory surgical guidelines
RARC (MA)
MA110
Missing/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim
RARC (MA)
MA111
Missing/invalid purchase price of the test(s) and/or the performing laboratory's name and address
RARC (MA)
MA112
Missing/invalid group practice information
RARC (MA)
MA113
Incomplete/invalid taxpayer identification number submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill…
RARC (MA)
MA114
Missing/invalid information on where the services were furnished
RARC (MA)
MA115
Missing/invalid physical location where the service(s) were rendered in a Health Professional Shortage Area
RARC (MA)
MA116
Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution
RARC (MA)
MA117
This claim has been assessed a $1.00 user fee
RARC (MA)
MA118
No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance a…
RARC (MA)
MA120
Missing/invalid CLIA certification number
RARC (MA)
MA121
Missing/invalid x-ray date
RARC (MA)
MA122
Missing/invalid initial treatment date
RARC (MA)
MA123
Your center was not selected to participate in this study, therefore, we cannot pay for these services
RARC (MA)
MA125
Per legislation governing this program, payment constitutes payment in full
RARC (MA)
MA126
Pancreas transplant not covered unless kidney transplant performed
RARC (MA)
MA128
Missing/invalid FDA approval number
RARC (MA)
MA130
Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correc…
RARC (MA)
MA131
Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your…
RARC (MA)
MA132
Adjustment to the pre-demonstration rate
RARC (MA)
MA133
Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay
RARC (MA)
MA134
Missing/invalid provider number of the facility where the patient resides
RARC (MA)
N1
You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract, plan benefit docu…
RARC (N)
N2
This allowance has been made in accordance with the most appropriate course of treatment provision of the plan
RARC (N)
N3
Missing consent form
RARC (N)
N4
Missing/invalid prior Insurance Carrier(s) EOB
RARC (N)
N5
EOB received from previous payer. Claim not on file
RARC (N)
N6
Under FEHB law), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B
RARC (N)
N7
Processing of this claim/service has included consideration under Major Medical provisions
RARC (N)
N8
Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication
RARC (N)
N9
Adjustment represents the estimated amount a previous payer may pay
RARC (N)
N10
Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review
RARC (N)
N11
Denial reversed because of medical review
RARC (N)
N12
Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the po…
RARC (N)
N13
Payment based on professional/technical component modifier(s)
RARC (N)
N15
Services for a newborn must be billed separately
RARC (N)
N16
Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage
RARC (N)
N19
Procedure code incidental to primary procedure
RARC (N)
N20
Service not payable with other service rendered on the same date
RARC (N)
N21
Your line item has been separated into multiple lines to expedite handling
RARC (N)
N22
This procedure code was added/changed because it more accurately describes the services rendered
RARC (N)
N23
Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions
RARC (N)
N24
Missing/invalid Electronic Funds Transfer banking information
RARC (N)
N25
This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respec…
RARC (N)
N26
Missing itemized bill/statement
RARC (N)
N27
Missing/invalid treatment number
RARC (N)
N28
Consent form requirements not fulfilled
RARC (N)
N30
Patient ineligible for this service
RARC (N)
N31
Missing/invalid prescribing provider identifier
RARC (N)
N32
Claim must be submitted by the provider who rendered the service
RARC (N)
N33
No record of health check prior to initiation of treatment
RARC (N)
N34
Incorrect claim form/format for this service
RARC (N)
N35
Program integrity/utilization review decision
RARC (N)
N36
Claim must meet primary payer's processing requirements before we can consider payment
RARC (N)
N37
Missing/invalid tooth number/letter
RARC (N)
N39
Procedure code is not compatible with tooth number/letter
RARC (N)
N40
Missing radiology film(s)/image(s)
RARC (N)
N42
Missing mental health assessment
RARC (N)
N43
Bed hold or leave days exceeded
RARC (N)
N45
Payment based on authorized amount
RARC (N)
N46
Missing/invalid admission hour
RARC (N)
N47
Claim conflicts with another inpatient stay
RARC (N)
N48
Claim information does not agree with information received from other insurance carrier
RARC (N)
N49
Court ordered coverage information needs validation
RARC (N)
N50
Missing/invalid discharge information
RARC (N)
N51
Electronic interchange agreement not on file for provider/submitter
RARC (N)
N52
Patient not enrolled in the billing provider's managed care plan on the date of service
RARC (N)
N53
Missing/invalid point of pick-up address
RARC (N)
N54
Claim information is inconsistent with pre-certified/authorized services
RARC (N)
N55
Procedures for billing with group/referring/performing providers were not followed
RARC (N)
N56
Procedure code billed is not correct/valid for the services billed or the date of service billed
RARC (N)
N57
Missing/invalid prescribing date
RARC (N)
N58
Missing/invalid patient liability amount
RARC (N)
N59
Please refer to your provider manual for additional program and provider information
RARC (N)
N61
Rebill services on separate claims
RARC (N)
N62
Dates of service span multiple rate periods. Resubmit separate claims
RARC (N)
N63
Rebill services on separate claim lines
RARC (N)
N64
The 'from' and 'to' dates must be different
RARC (N)
N65
Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider
RARC (N)
N67
Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the…
RARC (N)
N68
Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in…
RARC (N)
N69
PPS code changed by claims processing system
RARC (N)
N70
Consolidated billing and payment applies
RARC (N)
N71
Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept…
RARC (N)
N72
PPS code changed by medical reviewers. Not supported by clinical records
RARC (N)
N74
Resubmit with multiple claims, each claim covering services provided in only one calendar month
RARC (N)
N75
Missing/invalid tooth surface information
RARC (N)
N76
Missing/invalid number of riders
RARC (N)
N77
Missing/invalid designated provider number
RARC (N)
N78
The necessary components of the child and teen checkup were not completed
RARC (N)
N79
Service billed is not compatible with patient location information
RARC (N)
N80
Missing/invalid prenatal screening information
RARC (N)
N81
Procedure billed is not compatible with tooth surface code
RARC (N)
N82
Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement
RARC (N)
N83
No appeal rights. Adjudicative decision based on the provisions of a demonstration project
RARC (N)
N84
Further installment payments are forthcoming
RARC (N)
N85
This is the final installment payment
RARC (N)
N86
A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered
RARC (N)
N87
Home use of biofeedback therapy is not covered
RARC (N)
N88
This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billin…
RARC (N)
N89
Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remitta…
RARC (N)
N90
Covered only when performed by the attending physician
RARC (N)
N91
Services not included in the appeal review
RARC (N)
N92
This facility is not certified for digital mammography
RARC (N)
N93
A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim
RARC (N)
N94
Claim/Service denied because a more specific taxonomy code is required for adjudication
RARC (N)
N95
This provider type/provider specialty may not bill this service
RARC (N)
N96
Patient must be refractory to conventional therapy and be an appropriate surgical candidate such that implantation with anesthesia can occur
RARC (N)
N97
Patients with stress incontinence, urinary obstruction, and specific neurologic diseases which are associated with secondary manifestations of the above three indications are excl…
RARC (N)
N98
Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a…
RARC (N)
N99
Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated
RARC (N)
N103
Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furn…
RARC (N)
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…
RARC (N)
N105
This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI…
RARC (N)
N106
Payment for services furnished to Skilled Nursing Facility inpatients can only be made to the SNF. You must request payment from the SNF rather than the patient for this service
RARC (N)
N107
Services furnished to Skilled Nursing Facility inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services
RARC (N)
N108
Missing/invalid upgrade information
RARC (N)
N109
This claim/service was chosen for complex review
RARC (N)
N110
This facility is not certified for film mammography
RARC (N)
N111
No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated
RARC (N)
N112
This claim is excluded from your electronic remittance advice
RARC (N)
N113
Only one initial visit is covered per physician, group practice or provider
RARC (N)
N114
During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedul…
RARC (N)
N115
This decision was based on a Local Coverage Determination. An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy…
RARC (N)
N116
This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient i…
RARC (N)
N117
This service is paid only once in a patient's lifetime
RARC (N)
N118
This service is not paid if billed more than once every 28 days
RARC (N)
N119
This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility within those 28 days
RARC (N)
N120
Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode
RARC (N)
N121
Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility stay
RARC (N)
N122
Add-on code cannot be billed by itself
RARC (N)
N123
This is a split service and represents a portion of the units from the originally submitted service
RARC (N)
N124
Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the service/item. The patient is l…
RARC (N)
N125
Payment has been service/item because the information furnished does not substantiate the need for the service/item. If you have collected any amount from the patient, you must re…
RARC (N)
N126
Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported
RARC (N)
N127
This is a misdirected claim/service for a United Mine Workers of America beneficiary. Please submit claims to them
RARC (N)
N128
This amount represents the prior to coverage portion of the allowance
RARC (N)
N129
Not eligible due to the patient's age
RARC (N)
N130
Consult plan benefit documents/guidelines for information about restrictions for this service
RARC (N)
N131
Total payments under multiple contracts cannot exceed the allowance for this service
RARC (N)
N132
Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified
RARC (N)
N133
Services for predetermination and services requesting payment are being processed separately
RARC (N)
N134
This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service
RARC (N)
N135
Record fees are the patient's responsibility and limited to the specified co-payment
RARC (N)
N136
To obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at 912-8444 or 325-2548
RARC (N)
N137
The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulator…
RARC (N)
N138
In the event you disagree with the Dental Advisor's opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subs…
RARC (N)
N139
Under 32 CFR 199.13, a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determina…
RARC (N)
N140
You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act…
RARC (N)
N141
The patient was not residing in a long-term care facility during all or part of the service dates billed
RARC (N)
N142
The original claim was denied. Resubmit a new claim, not a replacement claim
RARC (N)
N143
The patient was not in a hospice program during all or part of the service dates billed
RARC (N)
N144
The rate changed during the dates of service billed
RARC (N)
N146
Missing screening document
RARC (N)
N147
Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request
RARC (N)
N148
Missing/invalid date of last menstrual period
RARC (N)
N149
Rebill all applicable services on a single claim
RARC (N)
N150
Missing/invalid model number
RARC (N)
N151
Telephone contact services will not be paid until the face-to-face contact requirement has been met
RARC (N)
N152
Missing/invalid replacement claim information
RARC (N)
N153
Missing/invalid room and board rate
RARC (N)
N154
This payment was delayed for correction of provider's mailing address
RARC (N)
N155
Our records do not indicate that other insurance is on file. Please submit other insurance information for our records
RARC (N)
N156
The patient is responsible for the difference between the approved treatment and the elective treatment
RARC (N)
N157
Transportation to/from this destination is not covered
RARC (N)
N158
Transportation in a vehicle other than an ambulance is not covered
RARC (N)
N159
Payment denied/reduced because mileage is not covered when the patient is not in the ambulance
RARC (N)
N160
The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service
RARC (N)
N161
This drug/service/supply is covered only when the associated service is covered
RARC (N)
N162
Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information…
RARC (N)
N163
Medical record does not support code billed per the code definition
RARC (N)
N167
Charges exceed the post-transplant coverage limit
RARC (N)
N170
A new/revised/renewed certificate of medical necessity is needed
RARC (N)
N171
Payment for repair or replacement is not covered or has exceeded the purchase price
RARC (N)
N172
The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item
RARC (N)
N173
No qualifying hospital stay dates were provided for this episode of care
RARC (N)
N174
This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'
RARC (N)
N175
Missing review organization approval
RARC (N)
N176
Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the Unite…
RARC (N)
N177
We did not send this claim to patient's other insurer. They have indicated no additional payment can be made
RARC (N)
N178
Missing pre-operative images/visual field results
RARC (N)
N179
Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information
RARC (N)
N180
This item or service does not meet the criteria for the category under which it was billed
RARC (N)
N181
Additional information is required from another provider involved in this service
RARC (N)
N182
This claim/service must be billed according to the schedule for this plan
RARC (N)
N183
This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits
RARC (N)
N184
Rebill technical and professional components separately
RARC (N)
N185
Do not resubmit this claim/service
RARC (N)
N186
Non-Availability Statement required for this service. Contact the nearest Military Treatment Facility for assistance
RARC (N)
N187
You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit docume…
RARC (N)
N188
The approved level of care does not match the procedure code submitted
RARC (N)
N189
This service has been paid as a one-time exception to the plan's benefit restrictions
RARC (N)
N190
Missing contract indicator
RARC (N)
N191
The provider must update insurance information directly with payer
RARC (N)
N192
Patient is a Medicaid/Qualified Medicare Beneficiary
RARC (N)
N193
Specific federal/state/local program may cover this service through another payer
RARC (N)
N194
Technical component not paid if provider does not own the equipment used
RARC (N)
N195
The technical component must be billed separately
RARC (N)
N196
Patient eligible to apply for other coverage which may be primary
RARC (N)
N197
The subscriber must update insurance information directly with payer
RARC (N)
N198
Rendering provider must be affiliated with the pay-to provider
RARC (N)
N199
Additional payment/recoupment approved based on payer-initiated review/audit
RARC (N)
N200
The professional component must be billed separately
RARC (N)
N202
Additional information/explanation will be sent separately
RARC (N)
N203
Missing/invalid anesthesia time/units
RARC (N)
N204
Services under review for possible pre-existing condition. Send medical records for prior 12 months
RARC (N)
N205
Information provided was illegible
RARC (N)
N206
The supporting documentation does not match the information sent on the claim
RARC (N)
N207
Missing/invalid weight
RARC (N)
N208
Missing/invalid DRG code
RARC (N)
N209
Missing/invalid taxpayer identification number
RARC (N)
N210
You may appeal this decision
RARC (N)
N211
You may not appeal this decision
RARC (N)
N212
Charges processed under a Point of Service benefit
RARC (N)
N213
Missing/invalid facility/discrete unit DRG/DRG exempt status information
RARC (N)
N214
Missing/invalid history of the related initial surgical procedure(s)
RARC (N)
N215
A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determi…
RARC (N)
N216
We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
RARC (N)
N217
We pay only one site of service per provider per claim
RARC (N)
N218
You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract o…
RARC (N)
N219
Payment based on previous payer's allowed amount
RARC (N)
N220
See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute
RARC (N)
N221
Missing Admitting History and Physical report
RARC (N)
N222
Incomplete/invalid Admitting History and Physical report
RARC (N)
N223
Missing documentation of benefit to the patient during initial treatment period
RARC (N)
N224
Incomplete/invalid documentation of benefit to the patient during initial treatment period
RARC (N)
N226
Incomplete/invalid American Diabetes Association Certificate of Recognition
RARC (N)
N227
Incomplete/invalid Certificate of Medical Necessity
RARC (N)
N228
Incomplete/invalid consent form
RARC (N)
N229
Incomplete/invalid contract indicator
RARC (N)
N230
Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply
RARC (N)
N231
Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used
RARC (N)
N232
Incomplete/invalid itemized bill/statement
RARC (N)
N233
Incomplete/invalid operative note/report
RARC (N)
N234
Incomplete/invalid oxygen certification/re-certification
RARC (N)
N235
Incomplete/invalid pacemaker registration form
RARC (N)
N236
Incomplete/invalid pathology report
RARC (N)
N237
Incomplete/invalid patient medical record for this service
RARC (N)
N238
Incomplete/invalid physician certified plan of care
RARC (N)
N239
Incomplete/invalid physician financial relationship form
RARC (N)
N240
Incomplete/invalid radiology report
RARC (N)
N241
Incomplete/invalid review organization approval
RARC (N)
N242
Incomplete/invalid radiology film(s)/image(s)
RARC (N)
N243
Incomplete/invalid/not approved screening document
RARC (N)
N244
Incomplete/Invalid pre-operative images/visual field results
RARC (N)
N245
Incomplete/invalid plan information for other insurance
RARC (N)
N246
State regulated patient payment limitations apply to this service
RARC (N)
N247
Missing/invalid assistant surgeon taxonomy
RARC (N)
N248
Missing/invalid assistant surgeon name
RARC (N)
N249
Missing/invalid assistant surgeon primary identifier
RARC (N)
N250
Missing/invalid assistant surgeon secondary identifier
RARC (N)
N251
Missing/invalid attending provider taxonomy
RARC (N)
N252
Missing/invalid attending provider name
RARC (N)
N253
Missing/invalid attending provider primary identifier
RARC (N)
N254
Missing/invalid attending provider secondary identifier
RARC (N)
N255
Missing/invalid billing provider taxonomy
RARC (N)
N256
Missing/invalid billing provider/supplier name
RARC (N)
N257
Missing/invalid billing provider/supplier primary identifier
RARC (N)
N258
Missing/invalid billing provider/supplier address
RARC (N)
N259
Missing/invalid billing provider/supplier secondary identifier
RARC (N)
N260
Missing/invalid billing provider/supplier contact information
RARC (N)
N261
Missing/invalid operating provider name
RARC (N)
N262
Missing/invalid operating provider primary identifier
RARC (N)
N263
Missing/invalid operating provider secondary identifier
RARC (N)
N264
Missing/invalid ordering provider name
RARC (N)
N265
Missing/invalid ordering provider primary identifier
RARC (N)
N266
Missing/invalid ordering provider address
RARC (N)
N267
Missing/invalid ordering provider secondary identifier
RARC (N)
N268
Missing/invalid ordering provider contact information
RARC (N)
N269
Missing/invalid other provider name
RARC (N)
N270
Missing/invalid other provider primary identifier
RARC (N)
N271
Missing/invalid other provider secondary identifier
RARC (N)
N272
Missing/invalid other payer attending provider identifier
RARC (N)
N273
Missing/invalid other payer operating provider identifier
RARC (N)
N274
Missing/invalid other payer other provider identifier
RARC (N)
N275
Missing/invalid other payer purchased service provider identifier
RARC (N)
N276
Missing/invalid other payer referring provider identifier
RARC (N)
N277
Missing/invalid other payer rendering provider identifier
RARC (N)
N278
Missing/invalid other payer service facility provider identifier
RARC (N)
N279
Missing/invalid pay-to provider name
RARC (N)
N280
Missing/invalid pay-to provider primary identifier
RARC (N)
N281
Missing/invalid pay-to provider address
RARC (N)
N282
Missing/invalid pay-to provider secondary identifier
RARC (N)
N283
Missing/invalid purchased service provider identifier
RARC (N)
N284
Missing/invalid referring provider taxonomy
RARC (N)
N285
Missing/invalid referring provider name
RARC (N)
N286
Missing/invalid referring provider primary identifier
RARC (N)
N287
Missing/invalid referring provider secondary identifier
RARC (N)
N288
Missing/invalid rendering provider taxonomy
RARC (N)
N289
Missing/invalid rendering provider name
RARC (N)
N290
Missing/invalid rendering provider primary identifier
RARC (N)
N291
Missing/invalid rendering provider secondary identifier
RARC (N)
N292
Missing/invalid service facility name
RARC (N)
N293
Missing/invalid service facility primary identifier
RARC (N)
N294
Missing/invalid service facility primary address
RARC (N)
N295
Missing/invalid service facility secondary identifier
RARC (N)
N296
Missing/invalid supervising provider name
RARC (N)
N297
Missing/invalid supervising provider primary identifier
RARC (N)
N298
Missing/invalid supervising provider secondary identifier
RARC (N)
N299
Missing/invalid occurrence date(s)
RARC (N)
N300
Missing/invalid occurrence span date(s)
RARC (N)
N301
Missing/invalid procedure date(s)
RARC (N)
N302
Missing/invalid other procedure date(s)
RARC (N)
N303
Missing/invalid principal procedure date
RARC (N)
N304
Missing/invalid dispensed date
RARC (N)
N305
Missing/invalid injury/accident date
RARC (N)
N306
Missing/invalid acute manifestation date
RARC (N)
N307
Missing/invalid adjudication or payment date
RARC (N)
N308
Missing/invalid appliance placement date
RARC (N)
N309
Missing/invalid assessment date
RARC (N)
N310
Missing/invalid assumed or relinquished care date
RARC (N)
N311
Missing/invalid authorized to return to work date
RARC (N)
N312
Missing/invalid begin therapy date
RARC (N)
N313
Missing/invalid certification revision date
RARC (N)
N314
Missing/invalid diagnosis date
RARC (N)
N315
Missing/invalid disability from date
RARC (N)
N316
Missing/invalid disability to date
RARC (N)
N317
Missing/invalid discharge hour
RARC (N)
N318
Missing/invalid discharge or end of care date
RARC (N)
N319
Missing/invalid hearing or vision prescription date
RARC (N)
N320
Missing/invalid Home Health Certification Period
RARC (N)
N321
Missing/invalid last admission period
RARC (N)
N322
Missing/invalid last certification date
RARC (N)
N323
Missing/invalid last contact date
RARC (N)
N324
Missing/invalid last seen/visit date
RARC (N)
N325
Missing/invalid last worked date
RARC (N)
N326
Missing/invalid last x-ray date
RARC (N)
N327
Missing/invalid other insured birth date
RARC (N)
N328
Missing/invalid Oxygen Saturation Test date
RARC (N)
N329
Missing/invalid patient birth date
RARC (N)
N330
Missing/invalid patient death date
RARC (N)
N331
Missing/invalid physician order date
RARC (N)
N332
Missing/invalid prior hospital discharge date
RARC (N)
N333
Missing/invalid prior placement date
RARC (N)
N334
Missing/invalid re-evaluation date
RARC (N)
N335
Missing/invalid referral date
RARC (N)
N336
Missing/invalid replacement date
RARC (N)
N337
Missing/invalid secondary diagnosis date
RARC (N)
N338
Missing/invalid shipped date
RARC (N)
N339
Missing/invalid similar illness or symptom date
RARC (N)
N340
Missing/invalid subscriber birth date
RARC (N)
N341
Missing/invalid surgery date
RARC (N)
N342
Missing/invalid test performed date
RARC (N)
N343
Missing/invalid Transcutaneous Electrical Nerve Stimulator trial start date
RARC (N)
N344
Missing/invalid Transcutaneous Electrical Nerve Stimulator trial end date
RARC (N)
N345
Date range not valid with units submitted
RARC (N)
N346
Missing/invalid oral cavity designation code
RARC (N)
N347
Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing…
RARC (N)
N348
You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier
RARC (N)
N349
The administration method and drug must be reported to adjudicate this service
RARC (N)
N350
Missing/invalid description of service for a Not Otherwise Classified code or for an Unlisted/By Report procedure
RARC (N)
N351
Service date outside of the approved treatment plan service dates
RARC (N)
N352
There are no scheduled payments for this service. Submit a claim for each patient visit
RARC (N)
N353
Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim
RARC (N)
N354
Incomplete/invalid invoice
RARC (N)
N355
The law permits exceptions to the refund requirement in two cases: - If you did not know, and could not have reasonably been expected to know, that we would not pay for this servi…
RARC (N)
N356
Not covered when performed with, or subsequent to, a non-covered service
RARC (N)
N357
Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met
RARC (N)
N358
This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted
RARC (N)
N359
Missing/invalid height
RARC (N)
N360
Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim
RARC (N)
N362
The number of Days or Units of Service exceeds our acceptable maximum
RARC (N)
N363
in the near future we are implementing new policies/procedures that would affect this determination
RARC (N)
N364
According to our agreement, you must waive the deductible and/or coinsurance amounts
RARC (N)
N366
Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice
RARC (N)
N367
The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account
RARC (N)
N368
You must appeal the determination of the previously adjudicated claim
RARC (N)
N369
Although this claim has been processed, it is deficient according to state legislation/regulation
RARC (N)
N370
Billing exceeds the rental months covered/approved by the payer
RARC (N)
N371
title of this equipment must be transferred to the patient
RARC (N)
N372
Only reasonable and necessary maintenance/service charges are covered
RARC (N)
N373
It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your…
RARC (N)
N374
Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required
RARC (N)
N375
Missing/invalid questionnaire/information required to determine dependent eligibility
RARC (N)
N376
Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE
RARC (N)
N377
Payment based on a processed replacement claim
RARC (N)
N378
Missing/invalid prescription quantity
RARC (N)
N379
Claim level information does not match line level information
RARC (N)
N380
The original claim has been processed, submit a corrected claim
RARC (N)
N381
Consult our contractual agreement for restrictions/billing/payment information related to these charges
RARC (N)
N382
Missing/invalid patient identifier
RARC (N)
N383
Not covered when deemed cosmetic
RARC (N)
N384
Records indicate that the referenced body part/tooth has been removed in a previous procedure
RARC (N)
N385
Notification of admission was not timely according to published plan procedures
RARC (N)
N386
This decision was based on a National Coverage Determination. An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and sea…
RARC (N)
N387
Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information
RARC (N)
N388
Missing/invalid prescription number
RARC (N)
N389
Duplicate prescription number submitted
RARC (N)
N390
This service/report cannot be billed separately
RARC (N)
N391
Missing emergency department records
RARC (N)
N392
Incomplete/invalid emergency department records
RARC (N)
N393
Missing progress notes/report
RARC (N)
N394
Incomplete/invalid progress notes/report
RARC (N)
N395
Missing laboratory report
RARC (N)
N396
Incomplete/invalid laboratory report
RARC (N)
N397
Benefits are not available for incomplete service(s)/undelivered item(s)
RARC (N)
N398
Missing elective consent form
RARC (N)
N399
Incomplete/invalid elective consent form
RARC (N)
N400
Electronically enabled providers should submit claims electronically
RARC (N)
N401
Missing periodontal charting
RARC (N)
N402
Incomplete/invalid periodontal charting
RARC (N)
N403
Missing facility certification
RARC (N)
N404
Incomplete/invalid facility certification
RARC (N)
N405
This service is only covered when the donor's insurer(s) do not provide coverage for the service
RARC (N)
N406
This service is only covered when the recipient's insurer(s) do not provide coverage for the service
RARC (N)
N407
You are not an approved submitter for this transmission format
RARC (N)
N408
This payer does not cover deductibles assessed by a previous payer
RARC (N)
N409
This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident
RARC (N)
N410
Not covered unless the prescription changes
RARC (N)
N411
This service is allowed one time in a 6-month period
RARC (N)
N412
This service is allowed 2 times in a 12-month period
RARC (N)
N413
This service is allowed 2 times in a benefit year
RARC (N)
N414
This service is allowed 4 times in a 12-month period
RARC (N)
N415
This service is allowed 1 time in an 18-month period
RARC (N)
N416
This service is allowed 1 time in a 3-year period
RARC (N)
N417
This service is allowed 1 time in a 5-year period
RARC (N)
N418
Misrouted claim. See the payer's claim submission instructions
RARC (N)
N419
Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change
RARC (N)
N420
Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery
RARC (N)
N421
Claim payment was the result of a payer's retroactive adjustment due to a review organization decision
RARC (N)
N422
Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program
RARC (N)
N423
Claim payment was the result of a payer's retroactive adjustment due to a non standard program
RARC (N)
N424
Patient does not reside in the geographic area required for this type of payment
RARC (N)
N425
Statutorily excluded service(s)
RARC (N)
N426
No coverage when self-administered
RARC (N)
N427
Payment for eyeglasses or contact lenses can be made only after cataract surgery
RARC (N)
N428
Not covered when performed in this place of service
RARC (N)
N429
Not covered when considered routine
RARC (N)
N430
Procedure code is inconsistent with the units billed
RARC (N)
N431
Not covered with this procedure
RARC (N)
N432
Adjustment based on a Recovery Audit
RARC (N)
N433
Resubmit this claim using only your NPI
RARC (N)
N434
Missing/invalid Present on Admission indicator
RARC (N)
N435
Exceeds number/frequency approved /allowed within time period without support documentation
RARC (N)
N436
The injury claim has not been accepted and a mandatory medical reimbursement has been made
RARC (N)
N437
If the injury claim is accepted, these charges will be reconsidered
RARC (N)
N438
This jurisdiction only accepts paper claims
RARC (N)
N439
Missing anesthesia physical status report/indicators
RARC (N)
N440
Incomplete/invalid anesthesia physical status report/indicators
RARC (N)
N441
This missed/cancelled appointment is not covered
RARC (N)
N442
Payment based on an alternate fee schedule
RARC (N)
N443
Missing/invalid total time or begin/end time
RARC (N)
N444
This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation
RARC (N)
N445
Missing document for actual cost or paid amount
RARC (N)
N446
Incomplete/invalid document for actual cost or paid amount
RARC (N)
N447
Payment is based on a generic equivalent as required documentation was not provided
RARC (N)
N448
This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement
RARC (N)
N449
Payment based on a comparable drug/service/supply
RARC (N)
N450
Covered only when performed by the primary treating physician or the designee
RARC (N)
N451
Missing Admission Summary Report
RARC (N)
N452
Incomplete/invalid Admission Summary Report
RARC (N)
N453
Missing Consultation Report
RARC (N)
N454
Incomplete/invalid Consultation Report
RARC (N)
N455
Missing Physician Order
RARC (N)
N456
Incomplete/invalid Physician Order
RARC (N)
N457
Missing Diagnostic Report
RARC (N)
N458
Incomplete/invalid Diagnostic Report
RARC (N)
N459
Missing Discharge Summary
RARC (N)
N460
Incomplete/invalid Discharge Summary
RARC (N)
N461
Missing Nursing Notes
RARC (N)
N462
Incomplete/invalid Nursing Notes
RARC (N)
N463
Missing support data for claim
RARC (N)
N464
Incomplete/invalid support data for claim
RARC (N)
N465
Missing Physical Therapy Notes/Report
RARC (N)
N466
Incomplete/invalid Physical Therapy Notes/Report
RARC (N)
N467
Missing Tests and Analysis Report
RARC (N)
N468
Incomplete/invalid Report of Tests and Analysis Report
RARC (N)
N469
Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003
RARC (N)
N470
This payment will complete the mandatory medical reimbursement limit
RARC (N)
N471
Missing/invalid HIPPS Rate Code
RARC (N)
N472
Payment for this service has been issued to another provider
RARC (N)
N473
Missing certification
RARC (N)
N474
Incomplete/invalid certification
RARC (N)
N475
Missing completed referral form
RARC (N)
N476
Incomplete/invalid completed referral form
RARC (N)
N477
Missing Dental Models
RARC (N)
N478
Incomplete/invalid Dental Models
RARC (N)
N479
Missing Explanation of Benefits
RARC (N)
N480
Incomplete/invalid Explanation of Benefits
RARC (N)
N481
Missing Models
RARC (N)
N482
Incomplete/invalid Models
RARC (N)
N485
Missing Physical Therapy Certification
RARC (N)
N486
Incomplete/invalid Physical Therapy Certification
RARC (N)
N487
Missing Prosthetics or Orthotics Certification
RARC (N)
N488
Incomplete/invalid Prosthetics or Orthotics Certification
RARC (N)
N489
Missing referral form
RARC (N)
N490
Incomplete/invalid referral form
RARC (N)
N491
Missing/invalid Exclusionary Rider Condition
RARC (N)
N492
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 fo…
RARC (N)
N493
Missing Doctor First Report of Injury
RARC (N)
N494
Incomplete/invalid Doctor First Report of Injury
RARC (N)
N495
Missing Supplemental Medical Report
RARC (N)
N496
Incomplete/invalid Supplemental Medical Report
RARC (N)
N497
Missing Medical Permanent Impairment or Disability Report
RARC (N)
N498
Incomplete/invalid Medical Permanent Impairment or Disability Report
RARC (N)
N499
Missing Medical Legal Report
RARC (N)
N500
Incomplete/invalid Medical Legal Report
RARC (N)
N501
Missing Vocational Report
RARC (N)
N502
Incomplete/invalid Vocational Report
RARC (N)
N503
Missing Work Status Report
RARC (N)
N504
Incomplete/invalid Work Status Report
RARC (N)
N505
This response includes only services that could be estimated in real-time. No estimate will be provided for the services that could not be estimated in real-time
RARC (N)
N506
This is an estimate of the member's liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be deter…
RARC (N)
N507
Plan distance requirements have not been met
RARC (N)
N508
This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electroni…
RARC (N)
N509
A current inquiry shows the member's Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spe…
RARC (N)
N510
A current inquiry shows the member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service. Actual payment from the Co…
RARC (N)
N511
Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time
RARC (N)
N512
This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication
RARC (N)
N513
This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication
RARC (N)
N516
Records indicate a mismatch between the submitted NPI and EIN
RARC (N)
N517
Resubmit a new claim with the requested information
RARC (N)
N518
No separate payment for accessories when furnished for use with oxygen equipment
RARC (N)
N519
Invalid combination of HCPCS modifiers
RARC (N)
N520
Payment made from a Consumer Spending Account
RARC (N)
N521
Mismatch between the submitted provider information and the provider information stored in our system
RARC (N)
N522
Duplicate of a claim processed, or to be processed, as a crossover claim
RARC (N)
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
RARC (N)
N524
Based on policy this payment constitutes payment in full
RARC (N)
N525
These services are not covered when performed within the global period of another service
RARC (N)
N526
Not qualified for recovery based on employer size
RARC (N)
N527
We processed this claim as the primary payer prior to receiving the recovery demand
RARC (N)
N528
Patient is entitled to benefits for Institutional Services only
RARC (N)
N529
Patient is entitled to benefits for Professional Services only
RARC (N)
N530
Not Qualified for Recovery based on enrollment information
RARC (N)
N531
Not qualified for recovery based on direct payment of premium
RARC (N)
N532
Not qualified for recovery based on disability and working status
RARC (N)
N533
Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan
RARC (N)
N534
This is an individual policy, the employer does not participate in plan sponsorship
RARC (N)
N535
Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service
RARC (N)
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
RARC (N)
N537
We have examined claims history and no records of the services have been found
RARC (N)
N538
A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents
RARC (N)
N539
We processed appeals/waiver requests on your behalf and that request has been denied
RARC (N)
N540
Payment adjusted based on the interrupted stay policy
RARC (N)
N541
Mismatch between the submitted insurance type code and the information stored in our system
RARC (N)
N542
Missing income verification
RARC (N)
N543
Incomplete/invalid income verification
RARC (N)
N544
Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future
RARC (N)
N545
Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing Incentive Program
RARC (N)
N546
Payment represents a previous reduction based on the Electronic Prescribing Incentive Program
RARC (N)
N547
A refund request was processed previously
RARC (N)
N548
Patient's calendar year deductible has been met
RARC (N)
N549
Patient's calendar year out-of-pocket maximum has been met
RARC (N)
N550
You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hol…
RARC (N)
N551
Payment adjusted based on the Ambulatory Surgical Center Quality Reporting Program
RARC (N)
N552
Payment adjusted to reverse a previous withhold/bonus amount
RARC (N)
N554
Missing/invalid Family Planning Indicator
RARC (N)
N555
Missing medication list
RARC (N)
N556
Incomplete/invalid medication list
RARC (N)
N557
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected
RARC (N)
N558
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received
RARC (N)
N559
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located
RARC (N)
N560
The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received
RARC (N)
N561
The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this rea…
RARC (N)
N562
The provider number of your incoming claim does not match the provider number on the processed Notice of Admission for this bundled payment
RARC (N)
N563
Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service
RARC (N)
N564
Patient did not meet the inclusion criteria for the demonstration project or pilot program
RARC (N)
N565
This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed
RARC (N)
N566
This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim…
RARC (N)
N567
Not covered when considered preventative
RARC (N)
N568
Initial payment based on the Notice of Admission under the Bundled Payment Model IV initiative
RARC (N)
N569
Not covered when performed for the reported diagnosis
RARC (N)
N570
Missing/invalid credentialing data
RARC (N)
N571
Payment will be issued quarterly by another payer/contractor
RARC (N)
N572
This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted
RARC (N)
N573
You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor
RARC (N)
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 acc…
RARC (N)
N575
Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records
RARC (N)
N576
Services not related to the specific incident/claim/accident/loss being reported
RARC (N)
N577
Personal Injury Protection Coverage
RARC (N)
N578
Coverages do not apply to this loss
RARC (N)
N579
Medical Payments Coverage
RARC (N)
N580
Determination based on the provisions of the insurance policy
RARC (N)
N581
Investigation of coverage eligibility is pending
RARC (N)
N582
Benefits suspended pending the patient's cooperation
RARC (N)
N583
Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person
RARC (N)
N584
Not covered based on the insured's noncompliance with policy or statutory conditions
RARC (N)
N585
Benefits are no longer available based on a final injury settlement
RARC (N)
N586
The injured party does not qualify for benefits
RARC (N)
N587
Policy benefits have been exhausted
RARC (N)
N588
The patient has instructed that medical claims/bills are not to be paid
RARC (N)
N589
Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by…
RARC (N)
N590
Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered
RARC (N)
N591
Payment based on an Independent Medical Examination or Utilization Review
RARC (N)
N592
Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription
RARC (N)
N593
Not covered based on failure to attend a scheduled Independent Medical Exam
RARC (N)
N594
Records reflect the injured party did not complete an Application for Benefits for this loss
RARC (N)
N595
Records reflect the injured party did not complete an Assignment of Benefits for this loss
RARC (N)
N596
Records reflect the injured party did not complete a Medical Authorization for this loss
RARC (N)
N597
Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries
RARC (N)
N598
Health care policy coverage is primary
RARC (N)
N599
Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as…
RARC (N)
N600
Adjusted based on the applicable fee schedule for the region in which the service was rendered
RARC (N)
N601
In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale Syste…
RARC (N)
N602
Adjusted based on the Redbook maximum allowance
RARC (N)
N603
This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage
RARC (N)
N604
In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule of Medical Fees, pursuant to R…
RARC (N)
N605
This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups, pursuant to Regulation 68
RARC (N)
N606
The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule. The allowed amount has been calculated in accordance with Section 4 of ORS 742.524
RARC (N)
N607
Service provided for non-compensable condition(s)
RARC (N)
N608
The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6
RARC (N)
N609
80% of the provider's billed amount is being recommended for payment according to Act 6
RARC (N)
N610
Payment based on an appropriate level of care
RARC (N)
N611
Claim in litigation. Contact insurer for more information
RARC (N)
N612
Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction
RARC (N)
N613
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…
RARC (N)
N614
Additional information is included in the 835
RARC (N)
N615
This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified…
RARC (N)
N616
This enrollee is in the first month of the advance premium tax credit grace period
RARC (N)
N617
This enrollee is in the second or third month of the advance premium tax credit grace period
RARC (N)
N618
This claim will automatically be reprocessed if the enrollee pays their premiums
RARC (N)
N619
Coverage terminated for non-payment of premium
RARC (N)
N620
This procedure code is for quality reporting/informational purposes only
RARC (N)
N621
Charges for Jurisdiction required forms, reports, or chart notes are not payable
RARC (N)
N622
Not covered based on the date of injury/accident
RARC (N)
N623
Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate
RARC (N)
N624
The associated Workers' Compensation claim has been withdrawn
RARC (N)
N625
Missing/invalid Workers' Compensation Claim Number
RARC (N)
N626
New or established patient E/M codes are not payable with chiropractic care codes
RARC (N)
N628
Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed
RARC (N)
N629
Reviews/documentation/notes/summaries/reports/charts not requested
RARC (N)
N630
Referral not authorized by attending physician
RARC (N)
N631
Medical Fee Schedule does not list this code. An allowance was made for a comparable service
RARC (N)
N633
Additional anesthesia time units are not allowed
RARC (N)
N634
The allowance is calculated based on anesthesia time units
RARC (N)
N635
The Allowance is calculated based on the anesthesia base units plus time
RARC (N)
N636
Adjusted because this is reimbursable only once per injury
RARC (N)
N637
Consultations are not allowed once treatment has been rendered by the same provider
RARC (N)
N638
Reimbursement has been made according to the home health fee schedule
RARC (N)
N639
Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule
RARC (N)
N640
Exceeds number/frequency approved/allowed within time period
RARC (N)
N641
Reimbursement has been based on the number of body areas rated
RARC (N)
N642
Adjusted when billed as individual tests instead of as a panel
RARC (N)
N643
The services billed are considered Not Covered or Non-Covered in the applicable state fee schedule
RARC (N)
N644
Reimbursement has been made according to the bilateral procedure rule
RARC (N)
N645
Mark-up allowance
RARC (N)
N646
Reimbursement has been adjusted based on the guidelines for an assistant
RARC (N)
N647
Adjusted based on diagnosis-related group
RARC (N)
N648
Adjusted based on Stop Loss
RARC (N)
N649
Payment based on invoice
RARC (N)
N650
This policy was not in effect for this date of loss. No coverage is available
RARC (N)
N651
No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss
RARC (N)
N652
The date of service is before the date of loss
RARC (N)
N653
The date of injury does not match the reported date of loss
RARC (N)
N654
Adjusted based on achievement of maximum medical improvement
RARC (N)
N655
Payment based on provider's geographic region
RARC (N)
N656
An interest payment is being made because benefits are being paid outside the statutory requirement
RARC (N)
N657
This should be billed with the appropriate code for these services
RARC (N)
N658
The billed service(s) are not considered medical expenses
RARC (N)
N659
This item is exempt from sales tax
RARC (N)
N660
Sales tax has been included in the reimbursement
RARC (N)
N661
Documentation does not support that the services rendered were medically necessary
RARC (N)
N662
Consideration of payment will be made upon receipt of a final bill
RARC (N)
N663
Adjusted based on an agreed amount
RARC (N)
N664
Adjusted based on a legal settlement
RARC (N)
N665
Services by an unlicensed provider are not reimbursable
RARC (N)
N666
Only one evaluation and management code at this service level is covered during the course of care
RARC (N)
N667
Missing prescription
RARC (N)
N668
Incomplete/invalid prescription
RARC (N)
N669
Adjusted based on the Medicare fee schedule
RARC (N)
N670
This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction rule
RARC (N)
N671
Payment based on a jurisdiction cost-charge ratio
RARC (N)
N672
Amount applied to Health Insurance Offset
RARC (N)
N673
Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount
RARC (N)
N674
Not covered unless a pre-requisite procedure/service has been provided
RARC (N)
N675
Additional information is required from the injured party
RARC (N)
N676
Service does not qualify for payment under the Outpatient Facility Fee Schedule
RARC (N)
N677
Films/Images will not be returned
RARC (N)
N678
Missing post-operative images/visual field results
RARC (N)
N679
Incomplete/Invalid post-operative images/visual field results
RARC (N)
N680
Missing/invalid date of previous dental extractions
RARC (N)
N681
Missing/invalid full arch series
RARC (N)
N682
Missing/invalid history of prior periodontal therapy/maintenance
RARC (N)
N683
Missing/invalid prior treatment documentation
RARC (N)
N684
Payment denied as this is a specialty claim submitted as a general claim
RARC (N)
N685
Missing/invalid Prosthesis, Crown or Inlay Code
RARC (N)
N686
Missing/invalid questionnaire needed to complete payment determination
RARC (N)
N687
This reversal is due to a retroactive disenrollment
RARC (N)
N688
This reversal is due to a medical or utilization review decision
RARC (N)
N689
This reversal is due to a retroactive rate change
RARC (N)
N690
This reversal is due to a provider submitted appeal
RARC (N)
N691
This reversal is due to a patient submitted appeal
RARC (N)
N692
This reversal is due to an incorrect rate on the initial adjudication
RARC (N)
N693
This reversal is due to a cancellation of the claim by the provider
RARC (N)
N694
This reversal is due to a resubmission/change to the claim by the provider
RARC (N)
N695
This reversal is due to incorrect patient financial responsibility information on the initial adjudication
RARC (N)
N696
This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment
RARC (N)
N697
This reversal is due to a payer's retroactive contract incentive program adjustment
RARC (N)
N698
This reversal is due to non-payment of the health insurance premiums by the end of the premium payment grace period, resulting in loss of coverage
RARC (N)
N699
Payment adjusted based on the Physician Quality Reporting System Incentive Program
RARC (N)
N700
Payment adjusted based on the Electronic Health Records Incentive Program
RARC (N)
N701
Payment adjusted based on the Value-based Payment Modifier
RARC (N)
N702
Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services
RARC (N)
N703
This service is incompatible with previously adjudicated claims or claims in process
RARC (N)
N704
You may not appeal this decision but can resubmit this claim/service with corrected information if warranted
RARC (N)
N705
Incomplete/invalid documentation
RARC (N)
N706
Missing documentation
RARC (N)
N707
Incomplete/invalid orders
RARC (N)
N708
Missing orders
RARC (N)
N709
Incomplete/invalid notes
RARC (N)
N710
Missing notes
RARC (N)
N711
Incomplete/invalid summary
RARC (N)
N712
Missing summary
RARC (N)
N713
Incomplete/invalid report
RARC (N)
N714
Missing report
RARC (N)
N715
Incomplete/invalid chart
RARC (N)
N716
Missing chart
RARC (N)
N717
Incomplete/Invalid documentation of face-to-face examination
RARC (N)
N718
Missing documentation of face-to-face examination
RARC (N)
N719
Penalty applied based on plan requirements not being met
RARC (N)
N720
The patient overpaid you. You may need to issue the patient a refund for the difference between the patient's payment and the amount shown as patient responsibility on this notice
RARC (N)
N721
This service is only covered when performed as part of a clinical trial
RARC (N)
N722
Patient must use Workers' Compensation Set-Aside funds to pay for the medical service or item
RARC (N)
N723
Patient must use Liability set-aside funds to pay for the medical service or item
RARC (N)
N724
Patient must use No-Fault set-aside funds to pay for the medical service or item
RARC (N)
N725
A liability insurer has reported having ongoing responsibility for medical services for this diagnosis
RARC (N)
N726
A conditional payment is not allowed
RARC (N)
N727
A no-fault insurer has reported having ongoing responsibility for medical services for this diagnosis
RARC (N)
N728
A workers' compensation insurer has reported having ongoing responsibility for medical services for this diagnosis
RARC (N)
N729
Missing patient medical/dental record for this service
RARC (N)
N730
Incomplete/invalid patient medical/dental record for this service
RARC (N)
N731
Incomplete/Invalid mental health assessment
RARC (N)
N732
Services performed at an unlicensed facility are not reimbursable
RARC (N)
N733
Regulatory surcharges are paid directly to the state
RARC (N)
N734
The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury
RARC (N)
N736
Incomplete/invalid Sleep Study Report
RARC (N)
N737
Missing Sleep Study Report
RARC (N)
N738
Incomplete/invalid Vein Study Report
RARC (N)
N739
Missing Vein Study Report
RARC (N)
N740
The member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service
RARC (N)
N741
This is a site neutral payment
RARC (N)
N743
Adjusted because the services may be related to an employment accident
RARC (N)
N744
Adjusted because the services may be related to an auto/other accident
RARC (N)
N745
Missing Ambulance Report
RARC (N)
N746
Incomplete/invalid Ambulance Report
RARC (N)
N747
This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides
RARC (N)
N748
Adjusted because the related hospital charges have not been received
RARC (N)
N749
Missing Blood Gas Report
RARC (N)
N750
Incomplete/invalid Blood Gas Report
RARC (N)
N751
Adjusted because the patient is covered under a Medicare Part D plan
RARC (N)
N752
Missing/invalid HIPPS Treatment Authorization Code
RARC (N)
N753
Missing/invalid Attachment Control Number
RARC (N)
N754
Missing/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form
RARC (N)
N755
Missing/invalid ICD Indicator
RARC (N)
N756
Missing/invalid point of drop-off address
RARC (N)
N757
Adjusted based on the Federal Indian Fees schedule
RARC (N)
N758
Adjusted based on the prior authorization decision
RARC (N)
N759
Payment adjusted based on the National Electrical Manufacturers Association Standard XR-29-2013
RARC (N)
N760
This facility is not authorized to receive payment for the service(s)
RARC (N)
N761
This provider is not authorized to receive payment for the service(s)
RARC (N)
N762
This facility is not certified for Tomosynthesis mammography
RARC (N)
N763
The demonstration code is not appropriate for this claim; resubmit without a demonstration code
RARC (N)
N764
Missing/invalid Hematocrit value
RARC (N)
N765
This payer does not cover coinsurance assessed by a previous payer
RARC (N)
N766
This payer does not cover co-payment assessed by a previous payer
RARC (N)
N767
The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed
RARC (N)
N768
Incomplete/invalid initial evaluation report
RARC (N)
N769
A lateral diagnosis is required
RARC (N)
N770
The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received
RARC (N)
N771
Under Federal law you cannot charge more than the limiting charge amount
RARC (N)
N772
Rebill urgent/emergent and ancillary services separately
RARC (N)
N773
Drug supplied not obtained from specialty vendor
RARC (N)
N774
Refer to your Third Party Processor Agreement for specific information on fees associated with this payment type
RARC (N)
N775
Payment adjusted based on x-ray radiograph on film
RARC (N)
N776
This service is not a covered Telehealth service
RARC (N)
N777
Missing Assignment of Benefits Indicator
RARC (N)
N778
Missing Primary Care Physician Information
RARC (N)
N779
Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received
RARC (N)
N780
Missing/invalid end therapy date
RARC (N)
N781
Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer
RARC (N)
N782
Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer
RARC (N)
N783
Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected copayment. This amount may be billed to a subsequent payer
RARC (N)
N784
Missing comprehensive procedure code
RARC (N)
N785
Missing current radiology film/images
RARC (N)
N786
Benefit limitation for the orthodontic active and/or retention phase of treatment
RARC (N)
N787
Under 42 CFR 410.43, an eligible Partial Hospitalization Program patient/beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP…
RARC (N)
N788
The third-party administrator/review organization did not receive the required information
RARC (N)
N789
Clinical Trial is not a covered benefit
RARC (N)
N790
Provider/supplier not accredited for product/service
RARC (N)
N791
Missing history & physical report
RARC (N)
N792
Incomplete/invalid history & physical report
RARC (N)
N794
Payment adjusted based on type of technology used
RARC (N)
N795
Item must be resubmitted as a purchase
RARC (N)
N796
Missing/invalid Hemoglobin value
RARC (N)
N797
Missing/invalid date qualifier
RARC (N)
N798
Submit a void request for the original claim and resubmit a new claim
RARC (N)
N799
Submitted identifier must be an individual identifier, not group identifier
RARC (N)
N800
Only one service date is allowed per claim
RARC (N)
N801
Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation 42 CFR 136
RARC (N)
N802
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located
RARC (N)
N803
Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital
RARC (N)
N804
The claim/service was processed through the Outpatient Code Editor
RARC (N)
N805
The claim/service was processed through the Correct Code Editor
RARC (N)
N806
Payment is included in the Global transplant allowance
RARC (N)
N807
Payment adjustment based on the Merit-based Incentive Payment System
RARC (N)
N808
Not covered for this provider type / provider specialty
RARC (N)
N809
The fee schedule amount for this service was adjusted based on prior competitive bidding rates. For more information, contact your local contractor
RARC (N)
N810
Due to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit. At the conclusion or expiration of the disaster declaration…
RARC (N)
N811
Missing Federal Sequestration Reduction from Prior Payer
RARC (N)
N812
The start service date through end service date cannot span greater than 18 months
RARC (N)
N815
Missing/invalid NDC Unit Count
RARC (N)
N816
Missing/invalid NDC Unit of Measure
RARC (N)
N817
Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 - March 31, 2020
RARC (N)
N818
Claims Dates of Service do not match Electronic Visit Verification System
RARC (N)
N819
Patient not enrolled in Electronic Visit Verification System
RARC (N)
N820
Electronic Visit Verification System units do not meet requirements of visit
RARC (N)
N821
Electronic Visit Verification System visit not found
RARC (N)
N822
Missing procedure modifier(s)
RARC (N)
N823
Incomplete/Invalid procedure modifier(s)
RARC (N)
N824
Electronic Visit Verification data must be submitted through EVV Vendor
RARC (N)
N825
Early intervention guidelines were not met
RARC (N)
N826
Patient did not meet the inclusion criteria for the Medicare Shared Savings Program
RARC (N)
N827
Missing/invalid Federal Information Processing Standard Code
RARC (N)
N828
Payment is suppressed due to a contracted funding
RARC (N)
N829
Missing/invalid Diagnostics Exchange Z-Code Identifier
RARC (N)
N830
The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations. As such, any amount identified with OA, CO, or PI…
RARC (N)
N831
You have not responded to requests to revalidate your provider/supplier enrollment information
RARC (N)
N832
Duplicate occurrence code/occurrence span code
RARC (N)
N833
Patient share of cost waived
RARC (N)
N834
Jurisdiction exempt from sales and health tax charges
RARC (N)
N835
Unrelated Service/procedure/treatment is reduced. The balance of this charge is the patient's responsibility
RARC (N)
N836
Provider W9 or Payee Registration not on file
RARC (N)
N837
Missing modifier was added
RARC (N)
N838
Service/procedure postponed due to a federal, state, or local mandate/disaster declaration. Any amounts applied to deductible or member liability will be applied to the prior plan…
RARC (N)
N839
The procedure code was added/changed because the level of service exceeds the compensable condition(s)
RARC (N)
N840
Worker's compensation claim filed with a different state
RARC (N)
N841
North Dakota Administrative Rule 92-01-02-50.3
RARC (N)
N842
Patient cannot be billed for charges
RARC (N)
N843
Missing/invalid Core-Based Statistical Area code
RARC (N)
N844
This claim, or a portion of this claim, was processed in accordance with the Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act
RARC (N)
N845
Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act
RARC (N)
N846
National Drug Code supplied does not correspond to the HCPCs/CPT billed
RARC (N)
N847
National Drug Code billed is obsolete
RARC (N)
N848
National Drug Code billed cannot be associated with a product
RARC (N)
N849
Missing Tooth Clause: Tooth missing prior to the member effective date
RARC (N)
N850
Missing/invalid narrative explaining/describing this service/treatment
RARC (N)
N851
Payment reduced because services were furnished by a therapy assistant
RARC (N)
N852
The pay-to and rendering provider tax identification numbers do not match
RARC (N)
N853
The number of modalities performed per session exceeds our acceptable maximum
RARC (N)
N854
If you have primary other health insurance coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbu…
RARC (N)
N855
This coverage is subject to the exclusive jurisdiction of ERISA, U.S.C. SEC 1001
RARC (N)
N856
This coverage is not subject to the exclusive jurisdiction of ERISA, U.S.C. SEC 1001
RARC (N)
N857
This claim has been adjusted/reversed. Refund any collected copayment to the member
RARC (N)
N858
State regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim. Payment amounts are eligible for dispute following the sta…
RARC (N)
N859
The Federal No Surprise Billing Act was applied to the processing of this claim. Payment amounts are eligible for dispute pursuant to any Federal documented appeal/ grievance/ dis…
RARC (N)
N860
The Federal No Surprise Billing Act Qualified Payment Amount was used to calculate the member cost share(s)
RARC (N)
N861
Mismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient
RARC (N)
N862
Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge
RARC (N)
N863
This claim is subject to the No Surprises Act. The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA
RARC (N)
N864
This claim is subject to the No Surprises Act provisions that apply to emergency services
RARC (N)
N865
This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating faci…
RARC (N)
N866
This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services
RARC (N)
N867
Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act
RARC (N)
N868
Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act
RARC (N)
N869
Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act
RARC (N)
N870
In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount
RARC (N)
N871
This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act
RARC (N)
N872
This final payment was calculated based on a specified state law, in accordance with the No Surprises Act
RARC (N)
N873
This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act
RARC (N)
N874
This final payment was determined through open negotiation, in accordance with the No Surprises Act
RARC (N)
N875
This final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act
RARC (N)
N876
This item or service is covered under the plan. This is a notice of denial of payment provided in accordance with the No Surprises Act. The provider or facility may initiate open…
RARC (N)
N877
This initial payment is provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-networ…
RARC (N)
N878
The provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and obtained in a manner consistent with…
RARC (N)
N879
The notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the billed services, is not permitted for…
RARC (N)
N880
Original claim closed due to changes in submitted data. Adjustment claim will be processed under a new claim number
RARC (N)
N881
Client Obligation, patient responsibility for Home & Community Based Services
RARC (N)
N882
The out-of-network payment and cost sharing amounts were based on the plan's allowance because the provider or facility obtained the patient's consent to waive the balance billing…
RARC (N)
N883
Processed according to state law
RARC (N)
N884
The No Surprises Act may apply to this claim. Please contact payer for instructions on how to submit information regarding whether or not the item or service was furnished during…
RARC (N)
N885
This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those re…
RARC (N)
N886
A Health Care Claim Request for Additional Information has been sent
RARC (N)
N887
Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not…
RARC (N)
N888
An electronic request for additional information has been sent for this claim
RARC (N)
N889
This claim was originally processed in real-time, and we sent a real-time 835 response
RARC (N)
N890
Electronic Visit Verification Data Element Requirements were not met
RARC (N)
N891
The maximum allowable payment for this service/procedure was paid by the primary insurance. No further payment due
RARC (N)
N892
The claim does not meet the criteria for acceptable use of the Delay Reason Code
RARC (N)
N893
Missing/invalid child medical evaluation form/checklist
RARC (N)
N894
These payments are made subject to a reservation of rights for the Payor to recoup or otherwise recover all or part of these payments based on any of the following: outcome of pen…
RARC (N)
N895
Processed based on a negotiated fee schedule for a specialty drug program
RARC (N)
N896
Missing/invalid trauma activation sheet
RARC (N)
N897
Missing/invalid proof of member payment
RARC (N)
N898
Missing/invalid Resource Utilization Group(s) code(s)
RARC (N)
N899
Missing Initial Evaluation Report
RARC (N)
N900
Missing Therapy Notes/Report
RARC (N)
N901
Incomplete/Invalid Therapy Notes/Report
RARC (N)
N902
Missing Health Risk Assessment
RARC (N)
N903
Incomplete/Invalid Health Risk Assessment
RARC (N)
N904
The transportation vendor is responsible for this claim
RARC (N)
N905
Provider opted out of Medicare; claim not payable. Patient is responsible, subject to limiting charge rules if applicable.
RARC (N)
N906
Service is not covered when patient is under age 45
RARC (N)
N907
No refund because this claim has been identified as 340B-eligible with a ceiling price lower than the maximum fair price
RARC (N)
N908
No refund because this drug has been prospectively purchased at the maximum fair price
RARC (N)
N909
Refund amount has been calculated using a methodology that differs from the Standard Default Refund Amount calculation times Quantity)
RARC (N)
N910
A refund cannot be provided for this claim at this time. Contact the manufacturer directly regarding your eligibility
RARC (N)
N911
This claim cannot be reimbursed by the manufacturer until the Part D plan submits corrected prescription drug event data to CMS for maximum fair price validation
RARC (N)
N912
Our records indicate that this beneficiary did not elect hospice
RARC (N)
N913
More than one Electronic Visit Verification record exists for the date and time of this service
RARC (N)
N914
This claim was priced and processed in accordance with California AB-72 Health care coverage
RARC (N)
N915
Predetermination of services is not allowed under the member's plan
RARC (N)
N916
The third party will render payment to the provider, and they will reimburse you for covered services
RARC (N)
N917
Alternative refund amount has been calculated because the maximum fair price is below the 340B ceiling price
RARC (N)
N918
No refund because CMS excludes prescription drug event records when a compound code indicates it is for a compounded drug
RARC (N)
N919
Family/member out-of-pocket maximum has been met
RARC (N)
N920
Payment to the provider has been placed on hold as a result of active contractnegotiation
RARC (N)
N921
The time limit for filing a reconsideration or appeal has expired
RARC (N)
N922
Missing primary care dentist information
RARC (N)
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Frequently asked questions

What is a CARC code?
A Claim Adjustment Reason Code (CARC) explains why a payer adjusted, reduced, or denied a payment on a claim line. It always appears with a Group Code (e.g., CO, PR, OA, PI) that shows who is financially responsible for the adjustment.
What is a RARC code?
A Remittance Advice Remark Code (RARC) provides extra detail that supplements a CARC on the remittance advice (ERA/EOB). Codes starting with MA or M are more general; codes starting with N convey specific remarks.
What is the difference between CARC and RARC?
A CARC states the reason for an adjustment; a RARC adds clarifying detail. A single claim line can carry one CARC plus one or more RARCs that together explain exactly what happened and why.
Where do I find these codes?
They appear on the Electronic Remittance Advice (ERA, 835) and the Explanation of Benefits (EOB) the payer returns after adjudicating a claim. Learn how to read them in our guide to the EOB.
Are these the official CMS code lists?
Yes — CARC and RARC are national code sets maintained for use in HIPAA transactions. Codes are updated periodically, so always confirm against the current official list before appealing a denial.