MLN Matters® Number: MM6453
Related Change Request (CR) #: 6453
Related CR Release Date: May 15, 2009
Effective Date: July 1, 2009
Related CR Transmittal #: R1734
Implementation Date: July 6, 2009
Provider Types Affected
Physicians, providers, and suppliers who submit claims to Medicare contractors (Carriers, Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), Medicare Administrative Contractors (MACs), Durable Medical Equipment Medicare Administrative Contractors (DME MACs)) for services.
Provider Action Needed
CR 6453, from which this article is taken, announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective July 1, 2009. Be sure billing staff is aware of these changes.
Background
The reason and remark code sets are used to report payment adjustments in remittance advice transactions. The reason codes are also used in some coordination-of-benefits (COB) transactions. The RARC list is maintained by the Centers for Medicare & Medicaid Services (CMS), and used by all payers; and additions, deactivations, and modifications to it may be initiated by any health care organization. The RARC list is updated 3 times a year – in early March, July, and November although the Committee meets every month.
The CARC list is maintained by a national Code Maintenance committee that meets when X12 meets for their trimester meetings (occurring in January/February, June, and September/October) to make decisions about additions, modifications, and retirement of existing reason codes. The CARC list is also updated 3 times a year – in early March, July, and November along with the RARC list.
Both code lists are posted at www.wpc-edi.com/Codes on the Internet. The lists at the end of the Additional Information section of this article summarize the latest changes to these lists, as announced in CR 6453.
CMS has also developed a tool to help you search for a specific category of remark code and that tool is available at www.cmsremarkcodes.info/ on the Internet. Note that this Web site does not replace the Washington Publishing Company (WPC) site. That site is www.wpc-edi.com/Codes and, should there be any discrepancies in what is posted at the CMS site and the WPC site, consider the WPC site to be correct.
Additional Information
As a reminder, CR 6336 noted that CARC 17 is being replaced with 2 new CARCs:
- 226: Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)
- 227: Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)
To see the official instruction (CR6453) issued to your Medicare Carrier, RHHI, DME/MAC, FI and/or MAC refer to www.cms.hhs.gov/Transmittals/downloads/R1734CP.pdf (PDF, 265 KB) on the CMS Web site.
For additional information about Remittance Advice, please refer to Understanding the Remittance Advice (RA):
A Guide for Medicare Providers, Physicians, Suppliers, and Billers at www.cms.hhs.gov/MLNProducts/downloads/RA_Guide_Full_03-22-06.pdf (PDF, 12.3 MB) on the CMS Web site.
If you have any questions, please contact our provider service center at our toll-free number, (877) 567-9249 (for North Carolina and South Carolina Part A providers) or (866) 801-5301 (for home health and hospice providers).
New Codes - CARC:
| Code | Current Narrative | Effective Date per WPC Posting |
| 229 |
Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer’s cost avoidance policy allows providers to bypass claim submission to a prior payer. Use Group Code PR. |
1/25/2009 |
| 230 |
No available or correlating CPT/HCPCS code to describe this service, Note: Used only by Property and Casualty |
1/25/2009 |
Modified Codes – CARC:
| Code | Current Narrative | Effective Date per WPC Posting |
| 187 |
Health Savings account payments. This change to be effective 10/1/2009: Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.) |
1/25/2009 |
Deactivated Codes - CARC:
| Code | Current Narrative | Effective Date |
| 17 |
Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) |
7/1/2009 |
| 156 |
Flexible spending account payments. Note: Use code 187. |
10/1/2009 |
New Codes - RARC:
| Code | Current Narrative | Medicare Initiated |
| N516 |
Records indicate a mismatch between the submitted NPI and EIN. |
NO |
| N517 |
Resubmit a new claim with the requested information |
YES |
| N518 |
No separate payment for accessories when furnished for use with oxygen equipment. |
YES |
Modified Codes – RARC:
| Code | Current Narrative | Medicare Initiated |
| M6 |
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.
Start: 01/01/1997 Last Modified: 03/01/2009
Notes: (Modified 4/1/07. 3/1/2009) |
YES |
| N109 |
This claim/service was chosen for complex review and was denied after reviewing the medical records.
Start: 02/28/2002 | Last Modified: 03/01/2009 Notes: (Modified 3/1/2009) |
YES |
| N387 |
Alert: Submit this claim to the patient’s other insurer for potential payment of supplemental benefits. We did not forward the claim information.
Start: 04/01/2007 | Last Modified: 03/01/2009 Notes: (Modified 3/1/2009) |
YES |
Deactivated Codes – RARC:
| Code | Current Narrative | Medicare Initiated |
| N515 |
Alert: Submit this claim to the patient’s other insurer for potential payment of supplemental benefits. We did not forward the claim information. (use N387 instead)
Start: 11/01/2008 | Stop: 10/01/2009 |
YES |
Disclaimer: This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.