Remittance Advice Remark Codes

X-ray not taken within the past 12 months or near enough to the start of treatment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not paid separately when the patient is an inpatient.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Equipment is the same or similar to equipment already being used.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This is the last monthly installment payment for this durable medical equipment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Equipment purchases are limited to the first or the tenth month of medical necessity.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Only one initial visit is covered per specialty per medical group.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.

Services you billed separately are considered part of another procedure already paid. Review NCCI edits.

Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 be liable for charges for the same service(s) under the same or similar conditions.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing oxygen certification/re-certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid HCPCS.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid place of residence for this service/item provided in a home.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid number of miles traveled.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing invoice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid number of doses per vial.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice. The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing operative note/report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing pathology report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing radiology report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered when the patient is under age 35.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim must be assigned and must be filed by the practitioner's employer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We do not pay for this as the patient has no legal obligation to pay for this.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The medical necessity form must be personally signed by the attending physician.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid condition code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid occurrence code(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid occurrence span code(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid value code(s) or amount(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid revenue code(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid procedure code(s).

A required procedure code (CPT/HCPCS) is missing, invalid, or cannot be identified from the claim as submitted.

Missing/incomplete/invalid 'from' date(s) of service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid days or units of service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid total charges.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid payer identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid 'to' date(s) of service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Certificate of Medical Necessity.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We cannot pay for this as the approval period for the FDA clinical trial has expired.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid treatment authorization code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other diagnosis.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 is subject to price limitations. Please submit the technical and professional components of this service as separate line items.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other procedure code(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Paid at the regular rate as you did not submit documentation to justify the modified procedure code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Total payment reduced due to overlap of tests billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service does not qualify for a HPSA/Physician Scarcity bonus payment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Multiple automated multichannel tests performed on the same day combined for payment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid diagnosis or condition.

A required diagnosis or condition code is not present or is incomplete. Often appears alongside CO-16.

Missing/incomplete/invalid/inappropriate place of service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid charge.

A submitted charge is missing, invalid, or incomplete on the claim form. Verify charge fields are properly populated.

Not covered when performed during the same session/date as a previously processed service for the patient.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

You are required to code to the highest level of specificity.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Service is not covered when patient is under age 50.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Service is not covered unless the patient is classified as at high risk.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Medical code sets used must be the codes in effect at the time of service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Subjected to review of physician evaluation and management services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Service denied because payment already made for same/similar procedure within set time frame.

The payer already paid for the same or a similar service within its allowed time frame. Review the prior paid service, frequency rules, modifiers, and coding logic before adjusting or rebilling.

Claim/service(s) subjected to CFO-CAP prepayment review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered more than once under age 40.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered more than once in a 12 month period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Lab procedures with different CLIA certification numbers must be billed on separate claims.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Information supplied does not support a break in therapy. A new capped rental period will not begin.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Services subjected to Home Health Initiative medical review/cost report audit.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Universal Product Number/Serial Number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Service not performed on equipment approved by the FDA for this purpose.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 projects, contact your local contractor.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This item is denied when provided to this patient by a non-contract or non-demonstration supplier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered unless submitted via electronic claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We pay for this service only when performed with a covered cryosurgical ablation.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid level of subluxation.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid name, strength, or dosage of the drug furnished.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing indication of whether the patient owns the equipment that requires the part or supply.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid individual lab codes included in the test.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing patient medical record for this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid indicator of x-ray availability for review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing physician financial relationship form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing pacemaker registration form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Performed by a facility/supplier in which the provider has a financial interest.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid plan of treatment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Part B coinsurance under a demonstration project or pilot program.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 participants.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Denied services exceed the coverage limit for the demonstration.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing physician certified plan of care.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing American Diabetes Association Certificate of Recognition.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The provider must update license information with the payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Pre-/post-operative care payment is included in the allowance for the surgery/procedure.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The claim information has also been forwarded to Medicaid for review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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, we are paying this time. In the future, we will not pay you for non-plan services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 secondary claim directly to that insurer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

SSA records indicate mismatch with name and sex.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment of less than $1.00 suppressed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Demand bill approved as result of medical review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

A patient may not elect to change a hospice provider more than once in a benefit period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Our records indicate that you were previously informed of this rule.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid entitlement number or name shown on the claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid type of bill.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid beginning and ending dates of the period billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid number of covered days during the billing period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid non-covered days during the billing period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid number of coinsurance days during the billing period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid number of lifetime reserve days.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient's address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid gender.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid admission date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid admission type.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid admission source.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient status.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: No appeal rights. Adjudicative decision based on law.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: As previously advised, a portion or all of your payment is being held in a special account.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The new information was considered but additional payment will not be issued.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid name or address of responsible party or primary payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Physician certification or election consent for hospice care not received timely.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Patient submitted written request to revoke his/her election for religious non-medical health care services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid release of information indicator.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient relationship to insured.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid social security number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This is a telephone review decision.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid principal diagnosis.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid admitting diagnosis.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid principal procedure code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Correction to a prior claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 assure correct and timely routing of the claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid remarks.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid provider representative signature.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid provider representative signature date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient or authorized representative signature.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient's payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Billed in excess of interim rate.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 demonstration project.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid provider/supplier signature.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Did not indicate whether we are the primary or secondary payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient's relationship to the insured for the primary payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid employment status code for the primary insured.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This determination is the result of the appeal you filed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing plan information for other insurance.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Non-PIP (Periodic Interim Payment) claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Medigap information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid date of current illness or symptoms.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Hemophilia Add On.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

PIP (Periodic Interim Payment) claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Paper claim contains more than three separate data items in field 19.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Paper claim contains more than one data item in field 23.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim processed in accordance with ambulatory surgical guidelines.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid group practice information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid information on where the services were furnished.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This claim has been assessed a $1.00 user fee.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 and/or deductible are applicable.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid CLIA certification number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid x-ray date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid initial treatment date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Your center was not selected to participate in this study, therefore, we cannot pay for these services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Per legislation governing this program, payment constitutes payment in full.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Pancreas transplant not covered unless kidney transplant performed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid FDA approval number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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/correct information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Adjustment to the pre-demonstration rate.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid provider number of the facility where the patient resides.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 documents or jurisdiction statutes. Refer to the URL provided in the ERA for the payer website to access the appeals process guidelines.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing consent form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

EOB received from previous payer. Claim not on file.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Under FEHB law (U.S.C. 8904(b)), 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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Processing of this claim/service has included consideration under Major Medical provisions.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Adjustment represents the estimated amount a previous payer may pay.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Denial reversed because of medical review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 portion of the charge that would have been covered by Medicare.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment based on professional/technical component modifier(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Services for a newborn must be billed separately.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Procedure code incidental to primary procedure.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Service not payable with other service rendered on the same date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Your line item has been separated into multiple lines to expedite handling.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This procedure code was added/changed because it more accurately describes the services rendered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 respect to claims processed on behalf of your benefit plan.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing itemized bill/statement.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid treatment number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Consent form requirements not fulfilled.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Patient ineligible for this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid prescribing provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim must be submitted by the provider who rendered the service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

No record of health check prior to initiation of treatment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incorrect claim form/format for this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Program integrity/utilization review decision.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim must meet primary payer's processing requirements before we can consider payment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid tooth number/letter.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Procedure code is not compatible with tooth number/letter.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing radiology film(s)/image(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing mental health assessment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Bed hold or leave days exceeded.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment based on authorized amount.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid admission hour.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim conflicts with another inpatient stay.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim information does not agree with information received from other insurance carrier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Court ordered coverage information needs validation.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid discharge information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Electronic interchange agreement not on file for provider/submitter.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Patient not enrolled in the billing provider's managed care plan on the date of service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid point of pick-up address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim information is inconsistent with pre-certified/authorized services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Procedures for billing with group/referring/performing providers were not followed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Procedure code billed is not correct/valid for the services billed or the date of service billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid prescribing date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient liability amount.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Please refer to your provider manual for additional program and provider information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Rebill services on separate claims.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Dates of service span multiple rate periods. Resubmit separate claims.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Rebill services on separate claim lines.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The 'from' and 'to' dates must be different.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient's admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: PPS (Prospective Payment System) code changed by claims processing system.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Consolidated billing and payment applies.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 assignment for these types of claims.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Resubmit with multiple claims, each claim covering services provided in only one calendar month.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid tooth surface information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid number of riders.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid designated provider number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The necessary components of the child and teen checkup (EPSDT) were not completed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Service billed is not compatible with patient location information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid prenatal screening information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Procedure billed is not compatible with tooth surface code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

No appeal rights. Adjudicative decision based on the provisions of a demonstration project.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Further installment payments are forthcoming.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This is the final installment payment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Home use of biofeedback therapy is not covered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 remittance advice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Covered only when performed by the attending physician.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Services not included in the appeal review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This facility is not certified for digital mammography.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim/Service denied because a more specific taxonomy code is required for adjudication.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This provider type/provider specialty may not bill this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 information for electronic claims processing.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid upgrade information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This claim/service was chosen for complex review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This facility is not certified for film mammography.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This claim is excluded from your electronic remittance advice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Only one initial visit is covered per physician, group practice or provider.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency's (HHA's) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is paid only once in a patient's lifetime.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is not paid if billed more than once every 28 days.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 (SNF) within those 28 days.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 (SNF) stay.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Add-on code cannot be billed by itself.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This is a split service and represents a portion of the units from the originally submitted service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice. The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This amount represents the prior to coverage portion of the allowance.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not eligible due to the patient's age.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Total payments under multiple contracts cannot exceed the allowance for this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Services for predetermination and services requesting payment are being processed separately.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Record fees are the patient's responsibility and limited to the specified co-payment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: To obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at (602) 912-8444 or (800) 325-2548.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 subscriber's dental insurance carrier for a second Independent Dental Advisor Review.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 as his/her representative and you disagree with the Dental Advisor's opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The patient was not residing in a long-term care facility during all or part of the service dates billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The original claim was denied. Resubmit a new claim, not a replacement claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The patient was not in a hospice program during all or part of the service dates billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The rate changed during the dates of service billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing screening document.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid date of last menstrual period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Rebill all applicable services on a single claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid model number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Telephone contact services will not be paid until the face-to-face contact requirement has been met.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid replacement claim information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid room and board rate.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This payment was delayed for correction of provider's mailing address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Transportation to/from this destination is not covered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Transportation in a vehicle other than an ambulance is not covered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This drug/service/supply is covered only when the associated service is covered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 will result in a denial of payment in the near future.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Medical record does not support code billed per the code definition.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Charges exceed the post-transplant coverage limit.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

A new/revised/renewed certificate of medical necessity is needed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment for repair or replacement is not covered or has exceeded the purchase price.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

No qualifying hospital stay dates were provided for this episode of care.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing review organization approval.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 United States must provide the service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: We did not send this claim to patient's other insurer. They have indicated no additional payment can be made.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing pre-operative images/visual field results.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This item or service does not meet the criteria for the category under which it was billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Additional information is required from another provider involved in this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This claim/service must be billed according to the schedule for this plan.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Rebill technical and professional components separately.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Do not resubmit this claim/service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 documents.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The approved level of care does not match the procedure code submitted.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing contract indicator.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The provider must update insurance information directly with payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Specific federal/state/local program may cover this service through another payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Technical component not paid if provider does not own the equipment used.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The technical component must be billed separately.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Patient eligible to apply for other coverage which may be primary.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The subscriber must update insurance information directly with payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Rendering provider must be affiliated with the pay-to provider.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Additional payment/recoupment approved based on payer-initiated review/audit.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The professional component must be billed separately.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Additional information/explanation will be sent separately.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid anesthesia time/units.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Services under review for possible pre-existing condition. Send medical records for prior 12 months

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Information provided was illegible.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The supporting documentation does not match the information sent on the claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid weight.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid DRG code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid taxpayer identification number (TIN).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: You may appeal this decision.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: You may not appeal this decision.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Charges processed under a Point of Service benefit.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid history of the related initial surgical procedure(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 determination.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

We pay only one site of service per provider per claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 or coverage manual.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment based on previous payer's allowed amount.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Admitting History and Physical report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Admitting History and Physical report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing documentation of benefit to the patient during initial treatment period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid documentation of benefit to the patient during initial treatment period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid American Diabetes Association Certificate of Recognition.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Certificate of Medical Necessity.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid consent form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid contract indicator.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid itemized bill/statement.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid operative note/report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid oxygen certification/re-certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid pacemaker registration form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid pathology report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid patient medical record for this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid physician certified plan of care.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid physician financial relationship form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid radiology report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid review organization approval.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid radiology film(s)/image(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid/not approved screening document.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/Invalid pre-operative images/visual field results.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid plan information for other insurance.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

State regulated patient payment limitations apply to this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid assistant surgeon taxonomy.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid assistant surgeon name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid assistant surgeon primary identifier.

The NPI for the assistant surgeon is missing, incomplete, or invalid on the claim. Required when an assistant surgeon is used for a procedure.

Missing/incomplete/invalid assistant surgeon secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid attending provider taxonomy.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid attending provider name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid attending provider primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid attending provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid billing provider taxonomy.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid billing provider/supplier name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid billing provider/supplier primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid billing provider/supplier address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid billing provider/supplier secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid billing provider/supplier contact information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid operating provider name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid operating provider primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid operating provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid ordering provider name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid ordering provider primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid ordering provider address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid ordering provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid ordering provider contact information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other provider name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other provider primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other payer attending provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other payer operating provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other payer other provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other payer purchased service provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other payer referring provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other payer rendering provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other payer service facility provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid pay-to provider name.

The payer could not validate the pay-to provider name submitted on the claim. Compare the submitted pay-to entity name with the payer enrollment record before resubmitting.

Missing/incomplete/invalid pay-to provider primary identifier.

The payer could not validate the primary identifier for the pay-to provider. Verify the billing or organizational identifier against payer enrollment before changing the claim.

Missing/incomplete/invalid pay-to provider address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid pay-to provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid purchased service provider identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid referring provider taxonomy.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid referring provider name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid referring provider primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid referring provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid rendering provider taxonomy.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid rendering provider name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid rendering provider primary identifier.

The rendering provider's NPI is missing or invalid. Every claim must include a valid rendering NPI.

Missing/incomplete/invalid rendering provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid service facility name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid service facility primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid service facility primary address.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid service facility secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid supervising provider name.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid supervising provider primary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid supervising provider secondary identifier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid occurrence date(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid occurrence span date(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid procedure date(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other procedure date(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid principal procedure date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid dispensed date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid injury/accident date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid acute manifestation date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid adjudication or payment date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid appliance placement date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid assessment date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid assumed or relinquished care date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid authorized to return to work date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid begin therapy date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid certification revision date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid diagnosis date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid disability from date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid disability to date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid discharge hour.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid discharge or end of care date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid hearing or vision prescription date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Home Health Certification Period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid last admission period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid last certification date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid last contact date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid last seen/visit date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid last worked date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid last x-ray date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid other insured birth date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Oxygen Saturation Test date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient birth date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient death date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid physician order date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid prior hospital discharge date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid prior placement date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid re-evaluation date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid referral date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid replacement date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid secondary diagnosis date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid shipped date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid similar illness or symptom date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid subscriber birth date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid surgery date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid test performed date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Date range not valid with units submitted.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid oral cavity designation code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 the payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The administration method and drug must be reported to adjudicate this service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Service date outside of the approved treatment plan service dates.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: There are no scheduled payments for this service. Submit a claim for each patient visit.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid invoice.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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 service; or - If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service. If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position. If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision. The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination. The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered when performed with, or subsequent to, a non-covered service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid height.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: 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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The number of Days or Units of Service exceeds our acceptable maximum.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: in the near future we are implementing new policies/procedures that would affect this determination.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

You must appeal the determination of the previously adjudicated claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Billing exceeds the rental months covered/approved by the payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: title of this equipment must be transferred to the patient.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Only reasonable and necessary maintenance/service charges are covered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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 behalf.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment based on a processed replacement claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid prescription quantity.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim level information does not match line level information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The original claim has been processed, submit a corrected claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid patient identifier.

Patient identification information on the claim is missing, incomplete, or does not match payer records.

Not covered when deemed cosmetic.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Records indicate that the referenced body part/tooth has been removed in a previous procedure.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Notification of admission was not timely according to published plan procedures.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid prescription number.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Duplicate prescription number submitted.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service/report cannot be billed separately.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing emergency department records.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid emergency department records.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing progress notes/report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid progress notes/report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing laboratory report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid laboratory report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Benefits are not available for incomplete service(s)/undelivered item(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing elective consent form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid elective consent form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Electronically enabled providers should submit claims electronically.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing periodontal charting.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid periodontal charting.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing facility certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid facility certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is only covered when the donor's insurer(s) do not provide coverage for the service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is only covered when the recipient's insurer(s) do not provide coverage for the service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

You are not an approved submitter for this transmission format.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This payer does not cover deductibles assessed by a previous payer.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

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.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered unless the prescription changes.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is allowed one time in a 6-month period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is allowed 2 times in a 12-month period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is allowed 2 times in a benefit year.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is allowed 4 times in a 12-month period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is allowed 1 time in an 18-month period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is allowed 1 time in a 3-year period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This service is allowed 1 time in a 5-year period.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Misrouted claim. See the payer's claim submission instructions.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Claim payment was the result of a payer's retroactive adjustment due to a non standard program.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Patient does not reside in the geographic area required for this type of payment.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Statutorily excluded service(s).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

No coverage when self-administered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment for eyeglasses or contact lenses can be made only after cataract surgery.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered when performed in this place of service.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered when considered routine.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Procedure code is inconsistent with the units billed.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Not covered with this procedure.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Adjustment based on a Recovery Audit.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Resubmit this claim using only your National Provider Identifier (NPI).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/Incomplete/Invalid Present on Admission indicator.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Exceeds number/frequency approved /allowed within time period without support documentation.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

The injury claim has not been accepted and a mandatory medical reimbursement has been made.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: If the injury claim is accepted, these charges will be reconsidered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This jurisdiction only accepts paper claims.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing anesthesia physical status report/indicators.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid anesthesia physical status report/indicators.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This missed/cancelled appointment is not covered.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment based on an alternate fee schedule.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid total time or begin/end time.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing document for actual cost or paid amount.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid document for actual cost or paid amount.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment is based on a generic equivalent as required documentation was not provided.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment based on a comparable drug/service/supply.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Covered only when performed by the primary treating physician or the designee.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Admission Summary Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Admission Summary Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Consultation Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Consultation Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Physician Order.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Physician Order.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Diagnostic Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Diagnostic Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Discharge Summary.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Discharge Summary.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Nursing Notes.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Nursing Notes.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing support data for claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid support data for claim.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Physical Therapy Notes/Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Physical Therapy Notes/Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Tests and Analysis Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Report of Tests and Analysis Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

This payment will complete the mandatory medical reimbursement limit.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/incomplete/invalid HIPPS Rate Code.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Payment for this service has been issued to another provider.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing completed referral form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid completed referral form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Dental Models.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Dental Models.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Models.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Models.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Physical Therapy Certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Physical Therapy Certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Prosthetics or Orthotics Certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Prosthetics or Orthotics Certification.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing referral form.

The payer requires a referral form (typically from the PCP to a specialist) but one was not submitted or is not on file. Extremely common on UHC, Aetna, and Cigna HMO plans.

Incomplete/invalid referral form.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing/Incomplete/Invalid Exclusionary Rider Condition.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Alert: A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Doctor First Report of Injury.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Doctor First Report of Injury.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Supplemental Medical Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Supplemental Medical Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Medical Permanent Impairment or Disability Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Medical Permanent Impairment or Disability Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Medical Legal Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Medical Legal Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Vocational Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Vocational Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Missing Work Status Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.

Incomplete/invalid Work Status Report.

Current X12 remark-code meaning. Read this RARC with the accompanying CARC, group code, line-level remittance detail, payer portal, and claim history before choosing an action.