Claim Adjustment Reason Codes-CARC Codes

Claim Adjustment Reason Codes list or CARC Codes List are standardized codes used in the healthcare industry to explain adjustments and denials made to medical claims submitted by providers to insurance companies or other payers. These codes help communicate the reasons for changes in the payment amount or the denial of a claim.

What are CARC codes?

Claim Adjustment Reason Codes (CARCs) are standardized codes used in the medical billing and healthcare industry to explain the reasons for adjustments or denials made to medical claims.

When a provider submits a claim for reimbursement to an insurance company or payer, the claim may undergo review and processing. During this process, the payer may identify certain issues that require adjustments to the payment or result in the denial of the claim.

These codes are standardized by the American National Standards Institute (ANSI) and the Centers for Medicare & Medicaid Services (CMS).

Here are a few examples of Claim Adjustment Reason Codes (CARCs) and their meanings:

  1. CA 29: “The time limit for filing has expired.” This code might be used when a claim is submitted after the allowed time frame for submission has passed.
  2. CA 97: “The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.” This code indicates that the payment for a specific service is bundled or included within the payment for another related service.

Claim Adjustment Reason Codes 2025

CARC CodesClaim Adjustment Reason Code Description
1Deductible Amount
2Coinsurance Amount
3Co-payment Amount
4The procedure code does not match the used modifier.
5The procedure code/type of bill is inconsistent with the place of service. Usage.
Identification Segment , if present.
6The procedure/revenue code is inconsistent with the patient’s age. Usage.
Identification Segment , if present.
7The procedure/revenue code is inconsistent with the patient’s gender.
Identification Segment , if present.
8The procedure code is inconsistent with the provider type/specialty (taxonomy).
9The diagnosis is inconsistent with the patient’s age.
10The diagnosis is inconsistent with the patient’s gender.
, if present.
11The diagnosis is inconsistent with the procedure.
12The diagnosis is inconsistent with the provider type.
, if present.
13The date of death precedes the date of service.
14The date of birth follows the date of service.
15The authorization number is missing, invalid, or does not apply to the billed services or provider.
16Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
17Requested 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.)
18Exact duplicate claim/service (Use only with Group Code OA except where state workers’ compensation regulations
requires CO)
19This is a work-related injury/illness and thus the liability of the Worker’s Compensation Carrier.
20This injury/illness is covered by the liability carrier.
21This injury/illness is the liability of the no-fault carrier.
22This care may be covered by another payer per coordination of benefits.
23The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)
24Charges are covered under a capitation agreement/managed care plan.
26Expenses incurred prior to coverage. (CARC 26)
27Expenses incurred after coverage terminated.
29The time limit for filing has expired.
31Patient cannot be identified as our insured.
32Our records indicate the patient is not an eligible dependent.
33Insured has no dependent coverage.
34Insured has no coverage for newborns.
35Lifetime benefit maximum has been reached.
39Services denied at the time authorization/pre-certification was requested.
40Charges do not meet qualifications for emergent/urgent care.
44Prompt-pay discount.
45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes
PR or CO depending upon liability)
49This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam.
50These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.
51These are non-covered services because this is a pre-existing condition.
53Services by an immediate relative or a member of the same household are not covered.
54Multiple physicians/assistants are not covered in this case.
Segment , if present.
55Procedure/treatment/drug is deemed experimental/investigational by the payer.
56Procedure/treatment has not been deemed ‘proven to be effective’ by the payer.
58Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
59Handled in accordance with rules related to multiple or concurrent procedures. This may involve situations such as multiple surgeries or diagnostic imaging, or concurrent anesthesia.
60Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient
services.
61Adjusted for failure to obtain second surgical opinion
66Blood Deductible.
69Day outlier amount.
70Cost outlier – Adjustment to compensate for additional costs.
74Indirect Medical Education Adjustment.
75Direct Medical Education Adjustment.
76Disproportionate Share Adjustment.
78Non-Covered days/Room charge adjustment.
33Insured has no dependent coverage.
34Insured has no coverage for newborns.
35Lifetime benefit maximum has been reached.
39Services denied at the time authorization/pre-certification was requested.
40Charges do not meet qualifications for emergent/urgent care.
44Prompt-pay discount.
45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes
PR or CO depending upon liability)
49This service is not covered as it falls under a routine/preventive examination or a diagnostic/screening procedure conducted alongside a routine/preventive exam.
50These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.
51These are non-covered services because this is a pre-existing condition.
53Services by an immediate relative or a member of the same household are not covered.
54Multiple physicians/assistants are not covered in this case.
55Procedure/treatment/drug is deemed experimental/investigational by the payer.
56Procedure/treatment has not been deemed ‘proven to be effective’ by the payer.
58Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
59Handled according to guidelines for multiple or concurrent procedures, such as multiple surgeries, diagnostic imaging, or concurrent anesthesia.
60Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient
services.
61Adjusted for failure to obtain second surgical opinion
66Blood Deductible.
69Day outlier amount.
70Cost outlier – Adjustment to compensate for additional costs.
74Indirect Medical Education Adjustment.
75Direct Medical Education Adjustment.
76Disproportionate Share Adjustment.
78Non-Covered days/Room charge adjustment.
85Patient Interest Adjustment (Use Only Group code PR)
89Professional fees removed from charges.
90Ingredient cost adjustment. Usage: To be used for pharmaceuticals only.
91Dispensing fee adjustment.
94Processed in Excess of charges.
95Plan procedures not followed.
96Charges not covered under the plan. Please ensure inclusion of at least one Remark Code (could be the NCPDP Reject Reason Code or Remittance Advice Remark Code that is not an ALERT).
97The benefit for this service is included in the payment/allowance for another service/procedure that has already been
adjudicated.
100Payment made to patient/insured/responsible party.
101Predetermination: anticipated payment upon completion of services or claim adjudication.
102Major Medical Adjustment.
103Provider promotional discount (Eg. Senior citizen discount).
104Managed care withholding.
105Tax withholding.
106Patient payment option/election not in effect.
107The related or qualifying claim/service was not identified on this claim.
108Rent/purchase guidelines were not met.
109Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
110Billing date predates service date.
111Not covered unless the provider accepts assignment.
112Service not furnished directly to the patient and/or not documented.
114Procedure/product not approved by the Food and Drug Administration.
115Procedure postponed, canceled, or delayed.
116The advance indemnification notice signed by the patient did not comply with requirements.
117Transportation is only covered to the closest facility that can provide the necessary care.
118ESRD network support adjustment.
119Benefit maximum for this time period or occurrence has been reached. (CARC 119)
121Indemnification adjustment – compensation for outstanding member responsibility.
122Psychiatric reduction.
128Newborn’s services are covered in the mother’s Allowance.
129Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of
either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
130Claim submission fee.
131Claim specific negotiated discount.
132Prearranged demonstration project adjustment.
133The disposition of this service line is pending further review. (Use only with Group Code OA).
134Technical fees removed from charges.
135Interim bills cannot be processed.
136Failure to follow prior payer’s coverage rules. (Use only with Group Code OA)
137Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
139Contracted funding agreement – Subscriber is employed by the provider of services. Use only with Group Code CO.
140Patient/Insured health identification number and name do not match.
142Monthly Medicaid patient liability amount.
143Portion of payment deferred.
144Incentive adjustment, e.g. preferred product/service.
146Diagnosis was invalid for the date(s) of service reported.
147Provider contracted/negotiated rate expired or not on file.
148Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be
provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
149Lifetime benefit maximum has been reached for this service/benefit category.
150Payer deems the information submitted does not support this level of service.
151Payment adjusted because the payer deems the information submitted does not support this many/frequency of
services.
152Payer deems the information submitted does not support this length of service.
153Payer deems the information submitted does not support this dosage.
154Payer deems the information submitted does not support this day’s supply.
155Patient refused the service/procedure.
157Service/procedure was provided as a result of an act of war.
158Service/procedure was provided outside of the United States.
159Service/procedure was provided as a result of terrorism.
160Injury/illness was the result of an activity that is a benefit exclusion.
161Provider performance bonus
163Attachment/other documentation referenced on the claim was not received.
164Attachment/other documentation referenced on the claim was not received in a timely fashion.
166These services were submitted after this payers responsibility for processing claims under this plan ended.
167This diagnosis is not covered.
169Alternate benefit has been provided.
170Payment is denied when performed/billed by this type of provider.
171Payment is denied when performed/billed by this type of provider in this type of facility.
172Payment is adjusted when performed/billed by a provider of this specialty.
173Service/equipment was not prescribed by a physician.
174Service was not prescribed prior to delivery.
175Prescription is incomplete.
176Prescription is not current.
177Patient has not met the required eligibility requirements.
178Patient has not met the required spend down requirements.
179Patient has not met the required waiting requirements.
180Patient has not met the required residency requirements.
181Procedure code was invalid on the date of service.
182Procedure modifier was invalid on the date of service.
183The referring provider is not eligible to refer the service billed.
184The prescribing/ordering provider is not eligible to prescribe/order the service billed.
185The rendering provider is not eligible to perform the service billed.
186Level of care change adjustment.
187Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)
188This product/procedure is only covered when used according to FDA recommendations.
189Not otherwise classified’ or ‘unlisted’ procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service
190Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.
192Non standard adjustment code from paper remittance. Usage: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non- standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment.
193Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.
194Anesthesia performed by the operating physician, the assistant surgeon or the attending physician.
195Refund issued to an erroneous priority payer for this claim/service.
197Precertification/authorization/notification/pre-treatment absent.
198Precertification/notification/authorization/pre-treatment exceeded.
199Revenue code and Procedure code do not match.
200Expenses incurred during lapse in coverage
201Patient is responsible for amount of this claim/service through ‘set aside arrangement’ or other agreement. (Use only with Group Code PR) At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
202Non-covered personal comfort or convenience services.
203Discontinued or reduced service.
204This service/equipment/drug is not covered under the patient’s current benefit plan
205Pharmacy discount card processing fee
206National Provider Identifier – missing.
207National Provider identifier – Invalid format
208National Provider Identifier – Not matched.
209Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount
may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA)
210Payment adjusted because pre-certification/authorization not received in a timely fashion
211National Drug Codes (NDC) not eligible for rebate, are not covered.
212Administrative surcharges are not covered
213Non-compliance with the physician self referral prohibition legislation or payer policy.
215Based on subrogation of a third party settlement
216Based on the findings of a review organization
219Determined by the severity of the injury. If the adjustment is made at the Claim Level, the payer is required to send and the provider should consult the 835 Insurance Policy Number Segment for jurisdictional regulations.
222Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.
223Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.
224Patient identification compromised by identity theft. Identity verification required for processing this and future claims.
225Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)
226The information requested from the Billing/Rendering Provider was either not provided, not provided in a timely manner, or was insufficient/incomplete. It is necessary to include at least one Remark Code (which could be the NCPDP Reject Reason Code or Remittance Advice Remark Code that is not an ALERT).
227Information 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 NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
228Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication
229Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Usage: 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 only with Group Code PR)
231Mutually exclusive procedures cannot be done in the same day/setting.
232Institutional Transfer Amount. Usage: Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions.
233Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
234This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the
NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
235Sales Tax
236This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
237Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
238Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. (Use only with Group Code PR)
239Claim spans eligible and ineligible periods of coverage. Rebill separate claims.
240The diagnosis is inconsistent with the patient’s birth weight.
241Low Income Subsidy (LIS) Co-payment Amount
242Services not provided by network/primary care providers. (CARC code 242)
243Services not authorized by network/primary care providers.
245Provider performance program withhold.
246This non-payable code is for required reporting only.
247Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
248Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
249This claim has been identified as a readmission. (Use only with Group Code CO)
250The attachment or other documentation that was received is not the correct attachment or document. The anticipated attachment or document is still absent.
251The attachment or other documentation that was received is incomplete or deficient. Essential information is still required to process the claim.
252An attachment/other documentation is required to adjudicate this claim/service.
253Sequestration – reduction in federal payment
254Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient’s
medical plan for further consideration.
256Service not payable per managed care contract.
257The status of the claim or service is uncertain during the grace period for premium payment, as mandated by Health Insurance Exchange regulations. This claim or service will be reversed and rectified after the grace period concludes, whether due to premium payment or lack thereof. (Use this code solely with Group Code OA).
258Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service.
259Additional payment for Dental/Vision service utilization.
260Processed under Medicaid ACA Enhanced Fee Schedule
261The procedure or service is inconsistent with the patient’s history.
262Adjustment for delivery cost. Usage: To be used for pharmaceuticals only.
263Adjustment for shipping cost. Usage: To be used for pharmaceuticals only.
264Adjustment for postage cost. Usage: To be used for pharmaceuticals only.
265Adjustment for administrative cost. Usage: To be used for pharmaceuticals only.
266Adjustment for compound preparation cost. Usage: To be used for pharmaceuticals only.
267Claim/service spans multiple months. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
268The Claim spans two calendar years. Please resubmit one claim per calendar year.
269Anesthesia not covered for this service/procedure.
270Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient’s
dental plan for further consideration.
271Prior contractual reductions related to a current periodic payment as part of a contractual payment schedule when
deferred amounts have been previously reported. (Use only with Group Code OA)
272Coverage/program guidelines were not met.
273Coverage/program guidelines were exceeded.
274Fee/Service not payable per patient Care Coordination arrangement.
275Prior payer’s (or payers’) patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group
Code PR)
276Services denied by the prior payers are not covered by this payer.
277The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)
278Performance program proficiency requirements not met.
279Services not provided by Preferred network providers. Usage: Use this code when there are member network limitations. For example, using contracted providers not in the member’s ‘narrow’ network.
280Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient’s Pharmacy plan for further consideration.
281Deductible waived per contractual agreement. Use only with Group Code CO.
282The procedure/revenue code is inconsistent with the type of bill.
283Attending provider is not eligible to provide direction of care.
284Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services.
285Appeal procedures not followed
286Appeal time limits not met
287Referral exceeded
288Referral absent
289Services considered under the dental and medical plans, benefits not available.
290Claim received by the dental plan, but benefits not available under this plan. Claim has been forwarded to the patient’s medical plan for further consideration.
291Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient’s dental plan for further consideration.
292Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient’s pharmacy plan for further consideration.
293Payment made to employer.
294Payment made to attorney.
295Pharmacy Direct/Indirect Remuneration (DIR)
296Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the provider.
297Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient’s vision plan for further consideration.
298Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient’s
vision plan for further consideration.
299The billing provider is not eligible to receive payment for the service billed.
300The claim has been received by the Medical Plan; however, the benefits are not covered under this particular plan. The claim has been subsequently referred to the patient’s Behavioral Health Plan for further evaluation and consideration.
301Claim received by the Medical Plan, but benefits not available under this plan. Submit these services to the patient’s Behavioral Health Plan for further consideration.
302Precertification/notification/authorization/pre-treatment time limit has expired.
303Prior payer’s (or payers’) patient responsibility (deductible, coinsurance, co-payment) not covered for Qualified
Medicare and Medicaid Beneficiaries. (Use only with Group Code CO)
304Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient’s
hearing plan for further consideration.
305Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient’s
hearing plan for further consideration.
A0Patient refund amount.
A1Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject
Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
A5Medicare Claim PPS Capital Cost Outlier Amount.
A6Prior hospitalization or 30 day transfer requirement not met.
A8Ungroupable DRG.
B1Non-covered visits.
B10Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not
liable for more than the charge limit for the basic procedure/test.
B11The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. (CARC b11)
B12Services not documented in patient’s medical records.
B13Previously paid. Payment for this claim/service may have been provided in a previous payment.
B14Only one visit or consultation per physician per day is covered.
B15This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other
service/procedure has not been received/adjudicated.
B16New Patient’ qualifications were not met.
B20Procedure/service was partially or fully furnished by another provider.
B22This payment is adjusted based on the diagnosis.
B23Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test.
B4Late filing penalty.
B5Coverage/program guidelines were not met or were exceeded.
B7This provider was not certified/eligible to be paid for this procedure/service on this date of service.
B8Alternative services were available, and should have been utilized.
B9Patient is enrolled in a Hospice.
P1State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. To
be used for Property and Casualty only.
P10Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To
be used for Property and Casualty only.
P11The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. To be used for
Property and Casualty only. (Use only with Group Code OA)
P12Workers’ compensation jurisdictional fee schedule adjustment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF).
P13Payment reduced or denied based on workers’ compensation jurisdictional regulations or payment policies, use only if no other code is applicable. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment if the regulations apply.
To be used for Workers’ Compensation only.
P14The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day.
P15Workers’ Compensation Medical Treatment Guideline Adjustment. To be used for Workers’ Compensation only.
P16Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for
Workers’ Compensation only. (Use with Group Code CO or OA)
P17Referral not authorized by attending physician per regulatory requirement. To be used for Property and Casualty only.
P18Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service. To be
used for Property and Casualty only.
P19Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. To be used for
Property and Casualty only.
P2Not a work related injury/illness and thus not the liability of the workers’ compensation carrier
2110 Service Payment information REF). To be used for Workers’ Compensation only.
P20Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only.
P21Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies.
P22Payment adjusted based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies.
if the regulations apply. To be used for Property and Casualty Auto only.
P23Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment.
P24Payment adjusted based on Preferred Provider Organization (PPO).
P25Payment adjusted based on Medical Provider Network (MPN).
P26Payment adjusted based on Voluntary Provider network (VPN).
P27Payment denied based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies.
P28Payment adjusted based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies.
P29Liability Benefits jurisdictional fee schedule adjustment.
P3Workers’ Compensation case settled. Patient is responsible for amount of this claim/service through WC ‘Medicare set aside arrangement’ or other agreement. To be used for Workers’ Compensation only. (Use only with Group Code PR)
P30Payment denied for exacerbation when supporting documentation was not complete. To be used for Property and
Casualty only.
P31Payment denied for exacerbation when treatment exceeds time allowed. To be used for Property and Casualty only.
P4Workers’ Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment.
P5Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. To be
used for Property and Casualty only.
P6Based on entitlement to benefits.
P7The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required.
To be used for Property and Casualty only.
P8Claim is under investigation.
P9No available or correlating CPT/HCPCS code to describe this service. To be used for Property and Casualty only.
CARC Codes List

CARC Group Code Description:

CARC Group CodesGroup Code Description
COContractual Obligation
CRCorrections and Reversal
OAOther Adjustment
PIPayer Initiated Reductions
PRPatient Responsibility
CARC Group Code Description

Remittance Advice Remark Codes (RARC)

RARCs are additional codes used on the EOB or remittance advice to provide supplementary information about adjustments described by the CARCs. They provide more specific details about the reason for an adjustment and often offer guidance on handling the situation or preventing similar issues in the future.

For example, some common RARC codes are:

  • RARC code N29: Missing/incomplete/invalid patient medical record for this service.
  • RARC code M86: Services by this non-physician provider are not covered when performed in this place of service.
  • RARC code N211: Alert: The rendering provider is not eligible to perform the service billed.
  • RARC code N130: Consult plan benefit documents/guidelines for information about restrictions for this service.

List of RARC Codes/Denial Codes

RARC CodesRARC Code Description
M1X-ray not taken within the past 12 months or near enough to the Started on of treatment.
M2Not paid separately when the patient is an inpatient.
M3Equipment is the same or similar to equipment already being used.
M4Alert: This is the last monthly installment payment for this durable medical equipment.
M5Monthly 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.
M6Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
M7No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price. (Previous Modified: 11/01/2016)
M8We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
M9Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement. (Previous Modified: 04/01/2007)
M10Equipment purchases are limited to the first or the tenth month of medical necessity.
M11DME, orthotics and prosthetics must be billed to the DME carrier who services the patient’s zip code.
M12Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
M13Only one initial visit is covered per specialty per medical group.
M14No 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.
M15Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
M16Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
M17Alert: 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.
M18Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient’s home.
M19Missing oxygen certification/re-certification.
M20Missing/incomplete/invalid HCPCS.
M21Missing/incomplete/invalid place of residence for this service/item provided in a home.
M22Missing/incomplete/invalid number of miles traveled.
M23Missing invoice.
M24Missing/incomplete/invalid number of doses per vial.
M25The 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.
M26The 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.
M27Alert: 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.
M28This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
M29Missing operative note/report.
M30Missing pathology report.
M31Missing radiology report.
M32Alert: 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.
M36This 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.
M37Not covered when the patient is under age 35.
M38Alert: 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.
M39Alert: 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.
M40Claim must be assigned and must be filed by the practitioner’s employer.
M41We do not pay for this as the patient has no legal obligation to pay for this.
M42The medical necessity form must be personally signed by the attending physician.
M44Missing/incomplete/invalid condition code.
(Previous Modified: 02/28/2003)
M45Missing/incomplete/invalid occurrence code(s).
M46Missing/incomplete/invalid occurrence span code(s).
M47Missing/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).
(Previous Modified: 07/01/2015)
M49Missing/incomplete/invalid value code(s) or amount(s).
M50Missing/incomplete/invalid revenue code(s).
M51Missing/incomplete/invalid procedure code(s). Related to N301
M52Missing/incomplete/invalid ‘from’ date(s) of service.
M53Missing/incomplete/invalid days or units of service.
M54Missing/incomplete/invalid total charges. (Previous Modified: 02/28/2003)
M55We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
M56Missing/incomplete/invalid payer identifier. (Previous Modified: 02/28/2003)
M59Missing/incomplete/invalid ‘to’ date(s) of service. (Previous Modified: 02/28/2003)
M60Missing Certificate of Medical Necessity. Previous Modified: 08/01/2004. Related to N227
M61We cannot pay for this as the approval period for the FDA clinical trial has expired.
M62Missing/incomplete/invalid treatment authorization code. (Previous Modified: 02/28/2003)
M64Missing/incomplete/invalid other diagnosis. (Previous Modified: 02/28/2003)
M65One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.
M66Our 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.
M67Missing/incomplete/invalid other procedure code(s).
M69Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
M70Alert: 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.
M71Total payment reduced due to overlap of tests billed.
M73The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
M74This service does not qualify for a HPSA/Physician Scarcity bonus payment.
M75Multiple automated multichannel tests performed on the same day combined for payment.
M76Missing/incomplete/invalid diagnosis or condition.
M77Missing/incomplete/invalid/inappropriate place of service.
M79Missing/incomplete/invalid charge.
M80Not covered when performed during the same session/date as a previously processed service for the patient.
M81You are required to code to the highest level of specificity.
M82Service is not covered when patient is under age 50.
M83Service is not covered unless the patient is classified as at high risk.
M84Medical code sets used must be the codes in effect at the time of service. (Previous Modified: 03/14/2014)
M85Subjected to review of physician evaluation and management services.
M86Service denied because payment already made for same/similar procedure within set time frame. (Previous Modified: 06/30/2003)
M87Claim/service(s) subjected to CFO-CAP prepayment review.
M89Not covered more than once under age 40.
M90Not covered more than once in a 12 month period.
M91Lab procedures with different CLIA certification numbers must be billed on separate claims.
M93Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
M94Information supplied does not support a break in therapy. A new capped rental period will not begin.
M95Services subjected to Home Health Initiative medical review/cost report audit.
M96The 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.
M97Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
M99Missing/incomplete/invalid Universal Product Number/Serial Number.
M100We 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.
M102Service not performed on equipment approved by the FDA for this purpose.
M103Information 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.
M104Information 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.
M105Information 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.
M107Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
M109We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
M111We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
M112Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.
M113Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
M114This 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.
M115This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
M116Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.
M117Not covered unless submitted via electronic claim.
M119Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
M121We pay for this service only when performed with a covered cryosurgical ablation.
M122Missing/incomplete/invalid level of subluxation.
M123Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
M124Missing indication of whether the patient owns the equipment that requires the part or supply.
M125Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
M126Missing/incomplete/invalid individual lab codes included in the test.
M127Missing patient medical record for this service. Related to N237
M129Missing/incomplete/invalid indicator of x-ray availability for review.
M130Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
M131Missing physician financial relationship form.
M132Missing pacemaker registration form.
M133Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
M134Performed by a facility/supplier in which the provider has a financial interest.
M135Missing/incomplete/invalid plan of treatment.
| Previous Modified: 02/28/2003
Notes: (Modified 2/28/03)
M136Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
| Previous Modified: 02/28/2003
Notes: (Modified 2/28/03)
M137Part B coinsurance under a demonstration project or pilot program.
| Previous Modified: 11/01/2012
Notes: (Modified 11/1/12)
M138Patient 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.
M139Denied services exceed the coverage limit for the demonstration.
M141Missing physician certified plan of care. Related to N238
M142Missing American Diabetes Association Certificate of Recognition. Related to N226
M143The provider must update license information with the payer.
M144Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
MA01Alert: 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.
MA02Alert: 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.
MA04Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
MA07Alert: The claim information has also been forwarded to Medicaid for review.
MA08Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
MA09Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.
MA10Alert: The patient’s payment was in excess of the amount owed. You must refund the overpayment to the patient.
MA12You 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).
MA13Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
MA14Alert: 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.
MA15Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
MA16The 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.
MA17We 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.
MA18Alert: The claim information is also being forwarded to the patient’s supplemental insurer. Send any questions regarding supplemental benefits to them.
MA19Alert: 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.
MA20Skilled 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.
MA21SSA records indicate mismatch with name and sex.
MA22Payment of less than $1.00 suppressed.
MA23Demand bill approved as result of medical review.
MA24Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
MA25A patient may not elect to change a hospice provider more than once in a benefit period.
MA26Alert: Our records indicate that you were previously informed of this rule.
MA27Missing/incomplete/invalid entitlement number or name shown on the claim.
MA28Alert: 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.
MA30Missing/incomplete/invalid type of bill.
MA31Missing/incomplete/invalid beginning and ending dates of the period billed.
MA32Missing/incomplete/invalid number of covered days during the billing period.
MA33Missing/incomplete/invalid non-covered days during the billing period.
MA34Missing/incomplete/invalid number of coinsurance days during the billing period.
MA35Missing/incomplete/invalid number of lifetime reserve days.
MA36Missing/incomplete/invalid patient name.
MA37Missing/incomplete/invalid patient’s address.
MA39Missing/incomplete/invalid gender.
MA40Missing/incomplete/invalid admission date.
MA41Missing/incomplete/invalid admission type.
MA42Missing/incomplete/invalid admission source.
MA43Missing/incomplete/invalid patient status.
MA44Alert: No appeal rights. Adjudicative decision based on law.
MA45Alert: As previously advised, a portion or all of your payment is being held in a special account.
MA46Alert: The new information was considered but additional payment will not be issued.
MA47Our 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.
MA48Missing/incomplete/invalid name or address of responsible party or primary payer.
MA50Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
MA53Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
MA54Physician certification or election consent for hospice care not received timely.
MA55Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
MA56Our 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.
MA57Patient submitted written request to revoke his/her election for religious non-medical health care services.
MA58Missing/incomplete/invalid release of information indicator.
MA59Alert: 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.
MA60Missing/incomplete/invalid patient relationship to insured.
MA61Missing/incomplete/invalid social security number.
MA62Alert: This is a telephone review decision.
MA63Missing/incomplete/invalid principal diagnosis.
MA64Our 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.
MA65Missing/incomplete/invalid admitting diagnosis.
MA66Missing/incomplete/invalid principal procedure code.
MA67Alert: Correction to a prior claim.
MA68Alert: 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.
MA69Missing/incomplete/invalid remarks.
MA70Missing/incomplete/invalid provider representative signature.
MA71Missing/incomplete/invalid provider representative signature date.
| Previous Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA72Alert: 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.
| Previous Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA73Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
MA74Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
| Previous Modified: 07/01/2015
Notes: (Modified 7/1/15)
MA75Missing/incomplete/invalid patient or authorized representative signature.
| Previous Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA76Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
| Previous Modified: 02/28/2003
Notes: (Modified 2/28/03, 2/1/04)
MA77Alert: 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.
| Previous Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA79Billed in excess of interim rate.
MA80Informational 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.
MA81Missing/incomplete/invalid provider/supplier signature.
MA83Did not indicate whether we are the primary or secondary payer.
MA84Patient 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.
MA88Missing/incomplete/invalid insured’s address and/or telephone number for the primary payer.
MA89Missing/incomplete/invalid patient’s relationship to the insured for the primary payer.
MA90Missing/incomplete/invalid employment status code for the primary insured.
MA91Alert: This determination is the result of the appeal you filed.
MA92Missing plan information for other insurance.
MA93Non-PIP (Periodic Interim Payment) claim.
MA94Did 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.
MA96Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
MA97Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
MA99Missing/incomplete/invalid Medigap information.
MA100Missing/incomplete/invalid date of current illness or symptoms.
MA103Hemophilia Add On.
MA106PIP (Periodic Interim Payment) claim.
MA107Paper claim contains more than three separate data items in field 19.
MA108Paper claim contains more than one data item in field 23.
MA109Claim processed in accordance with ambulatory surgical guidelines.
MA110Missing/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.
MA111Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory’s name and address.
MA112Missing/incomplete/invalid group practice information.
MA113Incomplete/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.
MA114Missing/incomplete/invalid information on where the services were furnished.
MA115Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
MA116Did not complete the statement ‘Homebound’ on the claim to validate whether laboratory services were performed at home or in an institution.
MA117This claim has been assessed a $1.00 user fee.
MA118Alert: 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.
MA120Missing/incomplete/invalid CLIA certification number.
MA121Missing/incomplete/invalid x-ray date.
MA122Missing/incomplete/invalid initial treatment date.
MA123Your center was not selected to participate in this study, therefore, we cannot pay for these services.
MA125Per legislation governing this program, payment constitutes payment in full.
MA126Pancreas transplant not covered unless kidney transplant performed.
MA128Missing/incomplete/invalid FDA approval number.
MA130Your 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.
MA131Physician 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.
MA132Adjustment to the pre-demonstration rate.
MA133Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
MA134Missing/incomplete/invalid provider number of the facility where the patient resides.
N1Alert: 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.
N2This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
N3Missing consent form.
N4Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.
N5EOB received from previous payer. Claim not on file.
N6Under 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.
N7Alert: Processing of this claim/service has included consideration under Major Medical provisions.
N8Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
N9Adjustment represents the estimated amount a previous payer may pay.
N10Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
N11Denial reversed because of medical review.
N12Policy 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.
N13Payment based on professional/technical component modifier(s).
N15Services for a newborn must be billed separately.
N16Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
N19Procedure code incidental to primary procedure.
N20Service not payable with other service rendered on the same date.
N21Alert: Your line item has been separated into multiple lines to expedite handling.
N22Alert: This procedure code was added/changed because it more accurately describes the services rendered.
N23Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
N24Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
N25This 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.
N26Missing itemized bill/statement.
N27Missing/incomplete/invalid treatment number.
N28Consent form requirements not fulfilled.
N30Patient ineligible for this service.
N31Missing/incomplete/invalid prescribing provider identifier.
N32Claim must be submitted by the provider who rendered the service.
N33No record of health check prior to initiation of treatment.
Started on: 01/01/2000
N34Incorrect claim form/format for this service.
N35Program integrity/utilization review decision.
N36Claim must meet primary payer’s processing requirements before we can consider payment.
N37Missing/incomplete/invalid tooth number/letter.
N39Procedure code is not compatible with tooth number/letter.
N40Missing radiology film(s)/image(s).
N42Missing mental health assessment.
N43Bed hold or leave days exceeded.
N45Payment based on authorized amount.
N46Missing/incomplete/invalid admission hour.
N47Claim conflicts with another inpatient stay.
N48Claim information does not agree with information received from other insurance carrier.
N49Court ordered coverage information needs validation.
N50Missing/incomplete/invalid discharge information.
N51Electronic interchange agreement not on file for provider/submitter.
N52Patient not enrolled in the billing provider’s managed care plan on the date of service.
N53Missing/incomplete/invalid point of pick-up address.
N54Claim information is inconsistent with pre-certified/authorized services.
N55Procedures for billing with group/referring/performing providers were not followed.
N56Procedure code billed is not correct/valid for the services billed or the date of service billed.
N57Missing/incomplete/invalid prescribing date.
N58Missing/incomplete/invalid patient liability amount.
N59Alert: Please refer to your provider manual for additional program and provider information.
N61Rebill services on separate claims.
N62Dates of service span multiple rate periods. Resubmit separate claims.
N63Rebill services on separate claim lines.
N64The ‘from’ and ‘to’ dates must be different.
N65Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
N67Professional 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.
N68Prior 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.
N69Alert: PPS (Prospective Payment System) code changed by claims processing system.
N70Consolidated billing and payment applies.
N71Your 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.
N72PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
N74Resubmit with multiple claims, each claim covering services provided in only one calendar month.
N75Missing/incomplete/invalid tooth surface information.
N76Missing/incomplete/invalid number of riders.
N77Missing/incomplete/invalid designated provider number.
N78The necessary components of the child and teen checkup (EPSDT) were not completed.
N79Service billed is not compatible with patient location information.
N80Missing/incomplete/invalid prenatal screening information.
N81Procedure billed is not compatible with tooth surface code.
N82Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
N83No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
N84Alert: Further installment payments are forthcoming.
N85Alert: This is the final installment payment.
N86A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
N87Home use of biofeedback therapy is not covered.
N88Alert: 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.
N89Alert: 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.
N90Covered only when performed by the attending physician.
N91Services not included in the appeal review.
N92This facility is not certified for digital mammography.
N93A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
N94Claim/Service denied because a more specific taxonomy code is required for adjudication.
N95This provider type/provider specialty may not bill this service.
N96Patient 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.
N97Patients 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.
N98Patient 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.
N99Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
N103Records 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.
N104This 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.
N105This 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.
N106Payment 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.
N107Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
N108Missing/incomplete/invalid upgrade information.
N109Alert: This claim/service was chosen for complex review.
N110This facility is not certified for film mammography.
N111No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
N112This claim is excluded from your electronic remittance advice.
N113Only one initial visit is covered per physician, group practice or provider.
N114During 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.
N115This 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.
N116Alert: 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.
N117This service is paid only once in a patient’s lifetime.
N118This service is not paid if billed more than once every 28 days.
N119This 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.
N120Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
N121Medicare 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.
N122Add-on code cannot be billed by itself.
N123Alert: This is a split service and represents a portion of the units from the originally submitted service.
N124Payment 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.
N125Payment 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.
N126Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.
N127This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
N128This amount represents the prior to coverage portion of the allowance.
N129Not eligible due to the patient’s age.
N130Consult plan benefit documents/guidelines for information about restrictions for this service.
N131Total payments under multiple contracts cannot exceed the allowance for this service.
N132Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.
N133Alert: Services for predetermination and services requesting payment are being processed separately.
N134Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.
N135Record fees are the patient’s responsibility and limited to the specified co-payment.
N136Alert: 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.
N137Alert: 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.
N138Alert: 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.
N139Alert: 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.
N140Alert: 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.
N141The patient was not residing in a long-term care facility during all or part of the service dates billed.
N142The original claim was denied. Resubmit a new claim, not a replacement claim.
N143The patient was not in a hospice program during all or part of the service dates billed.
N144The rate changed during the dates of service billed.
N146Missing screening document.
N147Long 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.
N148Missing/incomplete/invalid date of last menstrual period.
N149Rebill all applicable services on a single claim.
N150Missing/incomplete/invalid model number.
N151Telephone contact services will not be paid until the face-to-face contact requirement has been met.
N152Missing/incomplete/invalid replacement claim information.
N153Missing/incomplete/invalid room and board rate.
N154Alert: This payment was delayed for correction of provider’s mailing address.
N155Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
N156Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
N157Transportation to/from this destination is not covered.
N158Transportation in a vehicle other than an ambulance is not covered.
N159Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
N160The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
N161This drug/service/supply is covered only when the associated service is covered.
N162Alert: 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.
N163Medical record does not support code billed per the code definition.
N167Charges exceed the post-transplant coverage limit.
N170A new/revised/renewed certificate of medical necessity is needed.
N171Payment for repair or replacement is not covered or has exceeded the purchase price.
N172The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
N173No qualifying hospital stay dates were provided for this episode of care.
N174This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group ‘PR’.
N175Missing review organization approval. Related to N241
N176Services 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.
N177Alert: We did not send this claim to patient’s other insurer. They have indicated no additional payment can be made.
N178Missing pre-operative images/visual field results. Related to N244
N179Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.
N180This item or service does not meet the criteria for the category under which it was billed.
N181Additional information is required from another provider involved in this service.
N182This claim/service must be billed according to the schedule for this plan.
N183Alert: 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.
N184Rebill technical and professional components separately.
N185Alert: Do not resubmit this claim/service.
N186Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
N187Alert: 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.
N188The approved level of care does not match the procedure code submitted.
N189Alert: This service has been paid as a one-time exception to the plan’s benefit restrictions.
N190Missing contract indicator. Related to N229
N191The provider must update insurance information directly with payer.
N192Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.
N193Alert: Specific federal/state/local program may cover this service through another payer.
N194Technical component not paid if provider does not own the equipment used.
N195The technical component must be billed separately.
N196Alert: Patient eligible to apply for other coverage which may be primary.
N197The subscriber must update insurance information directly with payer.
N198Rendering provider must be affiliated with the pay-to provider.
N199Additional payment/recoupment approved based on payer-initiated review/audit.
N200The professional component must be billed separately.
N202Alert: Additional information/explanation will be sent separately.
N203Missing/incomplete/invalid anesthesia time/units.
N204Services under review for possible pre-existing condition. Send medical records for prior 12 months
N205Information provided was illegible.
N206The supporting documentation does not match the information sent on the claim.
N207Missing/incomplete/invalid weight.
N208Missing/incomplete/invalid DRG code.
N209Missing/incomplete/invalid taxpayer identification number (TIN).
N210Alert: You may appeal this decision.
N211Alert: You may not appeal this decision.
N212Charges processed under a Point of Service benefit.
N213Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
N214Missing/incomplete/invalid history of the related initial surgical procedure(s).
N215Alert: 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.
N216We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
N217We pay only one site of service per provider per claim.
N218You 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.
N219Payment based on previous payer’s allowed amount.
N220Alert: See the payer’s web site or contact the payer’s Customer Service department to obtain forms and instructions for filing a provider dispute.
N221Missing Admitting History and Physical report.
N222Incomplete/invalid Admitting History and Physical report.
N223Missing documentation of benefit to the patient during initial treatment period.
N224Incomplete/invalid documentation of benefit to the patient during initial treatment period.
N226Incomplete/invalid American Diabetes Association Certificate of Recognition.
N227Incomplete/invalid Certificate of Medical Necessity.
N228Incomplete/invalid consent form.
N229Incomplete/invalid contract indicator.
N230Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
N231Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
N232Incomplete/invalid itemized bill/statement.
N233Incomplete/invalid operative note/report.
N234Incomplete/invalid oxygen certification/re-certification.
N235Incomplete/invalid pacemaker registration form.
N236Incomplete/invalid pathology report.
N237Incomplete/invalid patient medical record for this service.
N238Incomplete/invalid physician certified plan of care.
N239Incomplete/invalid physician financial relationship form.
N240Incomplete/invalid radiology report.
N241Incomplete/invalid review organization approval.
N242Incomplete/invalid radiology film(s)/image(s).
N243Incomplete/invalid/not approved screening document.
N244Incomplete/Invalid pre-operative images/visual field results.
N245Incomplete/invalid plan information for other insuranc
N246State regulated patient payment limitations apply to this service.
N247Missing/incomplete/invalid assistant surgeon taxonomy.
N248Missing/incomplete/invalid assistant surgeon name.
N249Missing/incomplete/invalid assistant surgeon primary identifier.
N250Missing/incomplete/invalid assistant surgeon secondary identifier.
N251Missing/incomplete/invalid attending provider taxonomy.
N252Missing/incomplete/invalid attending provider name.
N253Missing/incomplete/invalid attending provider primary identifier.
N254Missing/incomplete/invalid attending provider secondary identifier.
N255Missing/incomplete/invalid billing provider taxonomy.
N256Missing/incomplete/invalid billing provider/supplier name.
N257Missing/incomplete/invalid billing provider/supplier primary identifier. (n257 remark code)
N258Missing/incomplete/invalid billing provider/supplier address.
N259Missing/incomplete/invalid billing provider/supplier secondary identifier.
N260Missing/incomplete/invalid billing provider/supplier contact information.
N261Missing/incomplete/invalid operating provider name.
N262Missing/incomplete/invalid operating provider primary identifier.
N263Missing/incomplete/invalid operating provider secondary identifier.
N264Missing/incomplete/invalid ordering provider name.
N265Missing/incomplete/invalid ordering provider primary identifier.
N266Missing/incomplete/invalid ordering provider address.
N267Missing/incomplete/invalid ordering provider secondary identifier.
N268Missing/incomplete/invalid ordering provider contact information.
N269Missing/incomplete/invalid other provider name.
N270Missing/incomplete/invalid other provider primary identifier.
N271Missing/incomplete/invalid other provider secondary identifier.
N272Missing/incomplete/invalid other payer attending provider identifier.
N273Missing/incomplete/invalid other payer operating provider identifier.
N274Missing/incomplete/invalid other payer other provider identifier.
N275Missing/incomplete/invalid other payer purchased service provider identifier.
N276Missing/incomplete/invalid other payer referring provider identifier.
N277Missing/incomplete/invalid other payer rendering provider identifier.
N278Missing/incomplete/invalid other payer service facility provider identifier.
N279Missing/incomplete/invalid pay-to provider name.
N280Missing/incomplete/invalid pay-to provider primary identifier.
N281Missing/incomplete/invalid pay-to provider address.
N282Missing/incomplete/invalid pay-to provider secondary identifier.
N283Missing/incomplete/invalid purchased service provider identifier.
N284Missing/incomplete/invalid referring provider taxonomy.
N285Missing/incomplete/invalid referring provider name.
N286Missing/incomplete/invalid referring provider primary identifier.
N287Missing/incomplete/invalid referring provider secondary identifier.
N288Missing/incomplete/invalid rendering provider taxonomy.
N289Missing/incomplete/invalid rendering provider name.
N290Missing/incomplete/invalid rendering provider primary identifier.
N291Missing/incomplete/invalid rendering provider secondary identifier.
N292Missing/incomplete/invalid service facility name.
N293Missing/incomplete/invalid service facility primary identifier.
N294Missing/incomplete/invalid service facility primary address.
N295Missing/incomplete/invalid service facility secondary identifier.
N296Missing/incomplete/invalid supervising provider name.
N297Missing/incomplete/invalid supervising provider primary identifier.
N298Missing/incomplete/invalid supervising provider secondary identifier.
N299Missing/incomplete/invalid occurrence date(s).
N300Missing/incomplete/invalid occurrence span date(s).
N301Missing/incomplete/invalid procedure date(s).
N302Missing/incomplete/invalid other procedure date(s).
N303Missing/incomplete/invalid principal procedure date.
N304Missing/incomplete/invalid dispensed date.
N305Missing/incomplete/invalid injury/accident date.
N306Missing/incomplete/invalid acute manifestation date.
N307Missing/incomplete/invalid adjudication or payment date.
N308Missing/incomplete/invalid appliance placement date.
N309Missing/incomplete/invalid assessment date.
N310Missing/incomplete/invalid assumed or relinquished care date.
N311Missing/incomplete/invalid authorized to return to work date.
N312Missing/incomplete/invalid begin therapy date.
N313Missing/incomplete/invalid certification revision date.
N314Missing/incomplete/invalid diagnosis date.
N315Missing/incomplete/invalid disability from date.
N316Missing/incomplete/invalid disability to date.
N317Missing/incomplete/invalid discharge hour.
N318Missing/incomplete/invalid discharge or end of care date.
N319Missing/incomplete/invalid hearing or vision prescription date.
N320Missing/incomplete/invalid Home Health Certification Period.
N321Missing/incomplete/invalid last admission period.
N322Missing/incomplete/invalid last certification date.
N323Missing/incomplete/invalid last contact date.
N324Missing/incomplete/invalid last seen/visit date.
N325Missing/incomplete/invalid last worked date.
N326Missing/incomplete/invalid last x-ray date.
N327Missing/incomplete/invalid other insured birth date.
N328Missing/incomplete/invalid Oxygen Saturation Test date.
N329Missing/incomplete/invalid patient birth date.
N330Missing/incomplete/invalid patient death date.
N331Missing/incomplete/invalid physician order date.
N332Missing/incomplete/invalid prior hospital discharge date.
N333Missing/incomplete/invalid prior placement date.
N334Missing/incomplete/invalid re-evaluation date.
N335Missing/incomplete/invalid referral date.
N336Missing/incomplete/invalid replacement date.
N337Missing/incomplete/invalid secondary diagnosis date.
N338Missing/incomplete/invalid shipped date.
N339Missing/incomplete/invalid similar illness or symptom date.
N340Missing/incomplete/invalid subscriber birth date.
N341Missing/incomplete/invalid surgery date.
N342Missing/incomplete/invalid test performed date.
N343Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial Started on date.
N344Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
N345Date range not valid with units submitted.
N346Missing/incomplete/invalid oral cavity designation code.
N347Your 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.
N348You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
N349The administration method and drug must be reported to adjudicate this service.
N350Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
N351Service date outside of the approved treatment plan service dates.
N352Alert: There are no scheduled payments for this service. Submit a claim for each patient visit.
N353Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.
N354Incomplete/invalid invoice.
N355Alert: 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
N356Not covered when performed with, or subsequent to, a non-covered service.
N357Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
N358Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
N359Missing/incomplete/invalid height.
N360Alert: 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.
N362The number of Days or Units of Service exceeds our acceptable maximum.
N363Alert: in the near future we are implementing new policies/procedures that would affect this determination.
N364Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.
N366Requested 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.
N367Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.
N368You must appeal the determination of the previously adjudicated claim.
N369Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.
N370Billing exceeds the rental months covered/approved by the payer.
N371Alert: title of this equipment must be transferred to the patient.
N372Only reasonable and necessary maintenance/service charges are covered.
N373It 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.
N374Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.
N375Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.
N376Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.
N377Payment based on a processed replacement claim.
Started on: 12/01/2006 | Previous Modified: 11/05/2007
Notes: (Modified 11/5/07)
N378Missing/incomplete/invalid prescription quantity.
N379Claim level information does not match line level information.
N380The original claim has been processed, submit a corrected claim.
N381Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.
N382Missing/incomplete/invalid patient identifier.
N383Not covered when deemed cosmetic.
Started on: 04/01/2007 | Previous Modified: 03/08/2011
Notes: (Modified 3/8/11)
N384Records indicate that the referenced body part/tooth has been removed in a previous procedure.
Started on: 04/01/2007
N385Notification of admission was not timely according to published plan procedures.
Started on: 04/01/2007 | Previous Modified: 11/05/2007
Notes: (Modified 11/5/07)
N386This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
Started on: 04/01/2007 | Previous Modified: 07/01/2010
Notes: (Modified 7/1/2010)
N387Alert: Submit this claim to the patient’s other insurer for potential payment of supplemental benefits. We did not forward the claim information.
Started on: 04/01/2007 | Previous Modified: 03/01/2009
Notes: (Modified 3/1/2009)
N388Missing/incomplete/invalid prescription number.
Started on: 08/01/2007 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N389Duplicate prescription number submitted.
Started on: 08/01/2007
N390This service/report cannot be billed separately.
Started on: 08/01/2007 | Previous Modified: 07/01/2008
Notes: (Modified 7/1/08)
N391Missing emergency department records.
Started on: 08/01/2007
N392Incomplete/invalid emergency department records.
Started on: 08/01/2007
N393Missing progress notes/report.
Started on: 08/01/2007 | Previous Modified: 07/01/2008
Notes: (Modified 7/1/08)
N394Incomplete/invalid progress notes/report.
Started on: 08/01/2007 | Previous Modified: 07/01/2008
Notes: (Modified 7/1/08)
N395Missing laboratory report.
Started on: 08/01/2007
N396Incomplete/invalid laboratory report.
Started on: 08/01/2007
N397Benefits are not available for incomplete service(s)/undelivered item(s).
Started on: 08/01/2007
N398Missing elective consent form.
Started on: 08/01/2007
N399Incomplete/invalid elective consent form.
Started on: 08/01/2007
N400Alert: Electronically enabled providers should submit claims electronically.
Started on: 08/01/2007
N401Missing periodontal charting.
Started on: 08/01/2007
N402Incomplete/invalid periodontal charting.
Started on: 08/01/2007
N403Missing facility certification.
Started on: 08/01/2007
N404Incomplete/invalid facility certification.
Started on: 08/01/2007
N405This service is only covered when the donor’s insurer(s) do not provide coverage for the service.
Started on: 08/01/2007
N406This service is only covered when the recipient’s insurer(s) do not provide coverage for the service.
Started on: 08/01/2007
N407You are not an approved submitter for this transmission format.
Started on: 08/01/2007
N408This payer does not cover deductibles assessed by a previous payer.
Started on: 08/01/2007
N409This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident.
Started on: 08/01/2007
N410Not covered unless the prescription changes.
Started on: 08/01/2007 | Previous Modified: 03/08/2011
Notes: (Modified 3/8/11)
N411This service is allowed one time in a 6-month period.
Started on: 08/01/2007 | Previous Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N412This service is allowed 2 times in a 12-month period.
Started on: 08/01/2007 | Previous Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N413This service is allowed 2 times in a benefit year.
Started on: 08/01/2007 | Previous Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N414This service is allowed 4 times in a 12-month period.
N415This service is allowed 1 time in an 18-month period.
N416This service is allowed 1 time in a 3-year period.
N417This service is allowed 1 time in a 5-year period.
Started on: 08/01/2007 | Previous Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N418Misrouted claim. See the payer’s claim submission instructions.
Started on: 08/01/2007
N419Claim payment was the result of a payer’s retroactive adjustment due to a retroactive rate change.
Started on: 08/01/2007
N420Claim payment was the result of a payer’s retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
Started on: 08/01/2007
N421Claim payment was the result of a payer’s retroactive adjustment due to a review organization decision.
Started on: 08/01/2007 | Previous Modified: 05/08/2008
Notes: (Modified 2/29/08, typo fixed 5/8/08)
N422Claim payment was the result of a payer’s retroactive adjustment due to a payer’s contract incentive program.
Started on: 08/01/2007 | Previous Modified: 05/08/2008
Notes: (Typo fixed 5/8/08)
N423Claim payment was the result of a payer’s retroactive adjustment due to a non standard program.
Started on: 08/01/2007
N424Patient does not reside in the geographic area required for this type of payment.
Started on: 08/01/2007
N425Statutorily excluded service(s).
Started on: 08/01/2007
N426No coverage when self-administered.
Started on: 08/01/2007
N427Payment for eyeglasses or contact lenses can be made only after cataract surgery.
Started on: 08/01/2007
N428Not covered when performed in this place of service.
Started on: 08/01/2007 | Previous Modified: 03/08/2011
Notes: (Modified 3/8/11)
N429Not covered when considered routine.
Started on: 08/01/2007 | Previous Modified: 03/08/2011
Notes: (Modified 3/8/11)
N430Procedure code is inconsistent with the units billed.
Started on: 11/05/2007
N431Not covered with this procedure.
Started on: 11/05/2007 | Previous Modified: 03/08/2011
Notes: (Modified 3/8/11)
N432Alert: Adjustment based on a Recovery Audit.
Started on: 11/05/2007 | Previous Modified: 07/01/2015
Notes: (Modified 7/1/15)
N433Resubmit this claim using only your National Provider Identifier (NPI).
Started on: 02/29/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N434Missing/Incomplete/Invalid Present on Admission indicator.
Started on: 07/01/2008
N435Exceeds number/frequency approved /allowed within time period without support documentation.
Started on: 07/01/2008
N436The injury claim has not been accepted and a mandatory medical reimbursement has been made.
Started on: 07/01/2008
N437Alert: If the injury claim is accepted, these charges will be reconsidered.
Started on: 07/01/2008
N438This jurisdiction only accepts paper claims.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N439Missing anesthesia physical status report/indicators.
Started on: 07/01/2008
N440Incomplete/invalid anesthesia physical status report/indicators.
Started on: 07/01/2008
N441This missed/cancelled appointment is not covered.
Started on: 07/01/2008 | Previous Modified: 07/15/2013
Notes: (Modified 7/15/2013)
N442Payment based on an alternate fee schedule.
Started on: 07/01/2008
N443Missing/incomplete/invalid total time or begin/end time.
Started on: 07/01/2008
N444Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers’ Compensation.
Started on: 07/01/2008
N445Missing document for actual cost or paid amount.
Started on: 07/01/2008
N446Incomplete/invalid document for actual cost or paid amount.
Started on: 07/01/2008
N447Payment is based on a generic equivalent as required documentation was not provided.
Started on: 07/01/2008
N448This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N449Payment based on a comparable drug/service/supply.
Started on: 07/01/2008
N450Covered only when performed by the primary treating physician or the designee.
Started on: 07/01/2008
N451Missing Admission Summary Report.
Started on: 07/01/2008
N452Incomplete/invalid Admission Summary Report.
Started on: 07/01/2008
N453Missing Consultation Report.
Started on: 07/01/2008
N454Incomplete/invalid Consultation Report.
Started on: 07/01/2008
N455Missing Physician Order.
Started on: 07/01/2008
N456Incomplete/invalid Physician Order.
Started on: 07/01/2008
N457Missing Diagnostic Report.
Started on: 07/01/2008
N458Incomplete/invalid Diagnostic Report.
Started on: 07/01/2008
N459Missing Discharge Summary.
Started on: 07/01/2008
N460Incomplete/invalid Discharge Summary.
Started on: 07/01/2008
N461Missing Nursing Notes.
Started on: 07/01/2008
N462Incomplete/invalid Nursing Notes.
Started on: 07/01/2008
N463Missing support data for claim.
Started on: 07/01/2008
N464Incomplete/invalid support data for claim.
Started on: 07/01/2008
N465Missing Physical Therapy Notes/Report.
Started on: 07/01/2008
N466Incomplete/invalid Physical Therapy Notes/Report.
Started on: 07/01/2008
N467Missing Tests and Analysis Report.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N468Incomplete/invalid Report of Tests and Analysis Report.
Started on: 07/01/2008
N469Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Started on: 07/01/2008
N470This payment will complete the mandatory medical reimbursement limit.
Started on: 07/01/2008
N471Missing/incomplete/invalid HIPPS Rate Code.
Started on: 07/01/2008
N472Payment for this service has been issued to another provider.
Started on: 07/01/2008
N473Missing certification.
Started on: 07/01/2008
N474Incomplete/invalid certification.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N475Missing completed referral form.
Started on: 07/01/2008
N476Incomplete/invalid completed referral form.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N477Missing Dental Models.
Started on: 07/01/2008
N478Incomplete/invalid Dental Models.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N479Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Started on: 07/01/2008
N480Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Started on: 07/01/2008
N481Missing Models.
Started on: 07/01/2008
N482Incomplete/invalid Models.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N485Missing Physical Therapy Certification.
Started on: 07/01/2008
N486Incomplete/invalid Physical Therapy Certification.
Started on: 07/01/2008
N487Missing Prosthetics or Orthotics Certification.
Started on: 07/01/2008
N488Incomplete/invalid Prosthetics or Orthotics Certification.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N489Missing referral form.
Started on: 07/01/2008
N490Incomplete/invalid referral form.
Started on: 07/01/2008 | Previous Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N491Missing/Incomplete/Invalid Exclusionary Rider Condition.
Started on: 07/01/2008
N492Alert: 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.
Started on: 07/01/2008
N493Missing Doctor First Report of Injury.
Started on: 07/01/2008
N494Incomplete/invalid Doctor First Report of Injury.
Started on: 07/01/2008
N495Missing Supplemental Medical Report.
Started on: 07/01/2008
N496Incomplete/invalid Supplemental Medical Report.
Started on: 07/01/2008
N497Missing Medical Permanent Impairment or Disability Report.
Started on: 07/01/2008
N498Incomplete/invalid Medical Permanent Impairment or Disability Report.
Started on: 07/01/2008
N499Missing Medical Legal Report.
Started on: 07/01/2008
N500Incomplete/invalid Medical Legal Report.
Started on: 07/01/2008
N501Missing Vocational Report.
Started on: 07/01/2008
N502Incomplete/invalid Vocational Report.
Started on: 07/01/2008
N503Missing Work Status Report.
Started on: 07/01/2008
N504Incomplete/invalid Work Status Report.
Started on: 07/01/2008
N505Alert: This response includes only services that could be estimated in real-time. No estimate will be provided for the services that could not be estimated in real-time.
Started on: 11/01/2008 | Previous Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N506Alert: This is an estimate of the member’s liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. This is not a pre-authorization or a guarantee of payment.
Started on: 11/01/2008
N507Plan distance requirements have not been met.
Started on: 11/01/2008
N508Alert: This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.
Started on: 11/01/2008 | Previous Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N509Alert: A current inquiry shows the member’s Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Started on: 11/01/2008
N510Alert: A current inquiry shows the member’s Consumer Spending Account does not contain sufficient funds to cover the member’s liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Started on: 11/01/2008
N511Alert: Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time.
Started on: 11/01/2008
N512Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.
Started on: 11/01/2008
N513Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.
Started on: 11/01/2008
N516Records indicate a mismatch between the submitted NPI and EIN.
Started on: 03/01/2009
N517Resubmit a new claim with the requested information.
Started on: 03/01/2009
N518No separate payment for accessories when furnished for use with oxygen equipment.
Started on: 03/01/2009
N519Invalid combination of HCPCS modifiers.
Started on: 07/01/2009
N520Alert: Payment made from a Consumer Spending Account.
Started on: 07/01/2009
N521Mismatch between the submitted provider information and the provider information stored in our system.
Started on: 11/01/2009
N522Duplicate of a claim processed, or to be processed, as a crossover claim.
Started on: 11/01/2009 | Previous Modified: 03/01/2010
N523The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid.
Started on: 03/01/2010
N524Based on policy this payment constitutes payment in full.
Started on: 03/01/2010
N525These services are not covered when performed within the global period of another service.
Started on: 03/01/2010
N526Not qualified for recovery based on employer size.
Started on: 03/01/2010
N527We processed this claim as the primary payer prior to receiving the recovery demand.
Started on: 03/01/2010
N528Patient is entitled to benefits for Institutional Services only.
Started on: 03/01/2010 | Previous Modified: 07/01/2010
Notes: (Modified 7/1/10)
N529Patient is entitled to benefits for Professional Services only.
Started on: 03/01/2010 | Previous Modified: 07/01/2010
Notes: (Modified 7/1/10)
N530Not Qualified for Recovery based on enrollment information.
Started on: 03/01/2010 | Previous Modified: 07/01/2010
Notes: (Modified 7/1/10)
N531Not qualified for recovery based on direct payment of premium.
Started on: 03/01/2010
N532Not qualified for recovery based on disability and working status.
Started on: 03/01/2010
N533Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
Started on: 07/01/2010
N534This is an individual policy, the employer does not participate in plan sponsorship.
Started on: 07/01/2010
N535Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
Started on: 07/01/2010
N536We are not changing the prior payer’s determination of patient responsibility, which you may collect, as this service is not covered by us.
Started on: 07/01/2010
N537We have examined claims history and no records of the services have been found.
Started on: 07/01/2010
N538A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
Started on: 07/01/2010
N539Alert: We processed appeals/waiver requests on your behalf and that request has been denied.
Started on: 07/01/2010
N540Payment adjusted based on the interrupted stay policy.
N541Mismatch between the submitted insurance type code and the information stored in our system.
N542Missing income verification.
N543Incomplete/invalid income verification.
N544Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future.
N545Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
N546Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
N547A refund request (Frequency Type Code 8) was processed previously.
Started on: 03/06/2012
N548Alert: Patient’s calendar year deductible has been met.
N549Alert: Patient’s calendar year out-of-pocket maximum has been met.
N550Alert: You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future.
N551Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.
N552Payment adjusted to reverse a previous withhold/bonus amount.
N554Missing/Incomplete/Invalid Family Planning Indicator.
N555Missing medication list.
N556Incomplete/invalid medication list.
N557This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected.
Started on: 07/01/2012
N558This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received.
Started on: 07/01/2012
N559This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located.
Started on: 07/01/2012
N560The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.
N561The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.
N562The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.
N563Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.
N564Patient did not meet the inclusion criteria for the demonstration project or pilot program.
N565Alert: This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed.
N566Alert: This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.
N567Not covered when considered preventative.
N568Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.
N569Not covered when performed for the reported diagnosis.
N570Missing/incomplete/invalid credentialing data.
N571Alert: Payment will be issued quarterly by another payer/contractor.
N572This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
N573Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.
N574Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider.
N575Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
N576Services not related to the specific incident/claim/accident/loss being reported.
N577Personal Injury Protection (PIP) Coverage.
N578Coverages do not apply to this loss.
N579Medical Payments Coverage (MPC).
N580Determination based on the provisions of the insurance policy.
N581Investigation of coverage eligibility is pending.
N582Benefits suspended pending the patient’s cooperation.
N583Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
N584Not covered based on the insured’s noncompliance with policy or statutory conditions.
N585Benefits are no longer available based on a final injury settlement.
N586The injured party does not qualify for benefits.
N587Policy benefits have been exhausted.
N588The patient has instructed that medical claims/bills are not to be paid.
N589Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by the use of a drug.
N590Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
N591Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
N592Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
N593Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
N594Records reflect the injured party did not complete an Application for Benefits for this loss.
N595Records reflect the injured party did not complete an Assignment of Benefits for this loss.
N596Records reflect the injured party did not complete a Medical Authorization for this loss.
N597Adjusted based on a medical/dental provider’s apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
N598Health care policy coverage is primary.
N599Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.
N600Adjusted based on the applicable fee schedule for the region in which the service was rendered.
N601In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii.
N602Adjusted based on the Redbook maximum allowance.
N603This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage.
N604In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers’ Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR.
N605This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
Started on: 07/15/2013
N606The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
Started on: 07/15/2013
N607Service provided for non-compensable condition(s).
Started on: 07/15/2013
N608The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6.
N60980% of the provider’s billed amount is being recommended for payment according to Act 6.
N610Alert: Payment based on an appropriate level of care.
N611Claim in litigation. Contact insurer for more information.
N612Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
N613Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.
N614Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
N615Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
N616Alert: This enrollee is in the first month of the advance premium tax credit grace period.
N617This enrollee is in the second or third month of the advance premium tax credit grace period.
N618Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
N619Coverage terminated for non-payment of premium.
N620Alert: This procedure code is for quality reporting/informational purposes only.
N621Charges for Jurisdiction required forms, reports, or chart notes are not payable.
N622Not covered based on the date of injury/accident.
N623Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
N624The associated Workers’ Compensation claim has been withdrawn.
N625Missing/Incomplete/Invalid Workers’ Compensation Claim Number.
N626New or established patient E/M codes are not payable with chiropractic care codes.
N628Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
N629Reviews/documentation/notes/summaries/reports/charts not requested.
N630Referral not authorized by attending physician.
N631Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
N633Additional anesthesia time units are not allowed.
N634The allowance is calculated based on anesthesia time units.
N635The Allowance is calculated based on the anesthesia base units plus time.
N636Adjusted because this is reimbursable only once per injury.
N637Consultations are not allowed once treatment has been rendered by the same provider.
N638Reimbursement has been made according to the home health fee schedule.
N639Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
N640Exceeds number/frequency approved/allowed within time period.
N641Reimbursement has been based on the number of body areas rated.
N642Adjusted when billed as individual tests instead of as a panel.
N643The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
N644Reimbursement has been made according to the bilateral procedure rule.
N645Mark-up allowance.
N646Reimbursement has been adjusted based on the guidelines for an assistant.
N647Adjusted based on diagnosis-related group (DRG).
N648Adjusted based on Stop Loss.
N649Payment based on invoice.
N650This policy was not in effect for this date of loss. No coverage is available.
N651No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
N652The date of service is before the date of loss.
N653The date of injury does not match the reported date of loss.
N654Adjusted based on achievement of maximum medical improvement (MMI).
N655Payment based on provider’s geographic region.
N656An interest payment is being made because benefits are being paid outside the statutory requirement.
N657This should be billed with the appropriate code for these services.
N658The billed service(s) are not considered medical expenses.
N659This item is exempt from sales tax.
N660Sales tax has been included in the reimbursement.
N661Documentation does not support that the services rendered were medically necessary.
N662Alert: Consideration of payment will be made upon receipt of a final bill.
N663Adjusted based on an agreed amount.
N664Adjusted based on a legal settlement.
N665Services by an unlicensed provider are not reimbursable.
N666Only one evaluation and management code at this service level is covered during the course of care.
N667Missing prescription.
N668Incomplete/invalid prescription.
N669Adjusted based on the Medicare fee schedule.
N670This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
N671Payment based on a jurisdiction cost-charge ratio.
N672Alert: Amount applied to Health Insurance Offset.
N673Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
N674Not covered unless a pre-requisite procedure/service has been provided.
N675Additional information is required from the injured party.
N676Service does not qualify for payment under the Outpatient Facility Fee Schedule.
N677Alert: Films/Images will not be returned.
N678Missing post-operative images/visual field results.
N679Incomplete/Invalid post-operative images/visual field results.
N680Missing/Incomplete/Invalid date of previous dental extractions.
N681Missing/Incomplete/Invalid full arch series.
N682Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
N683Missing/Incomplete/Invalid prior treatment documentation.
N684Payment denied as this is a specialty claim submitted as a general claim.
N685Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
N686Missing/incomplete/Invalid questionnaire needed to complete payment determination.
N687Alert: This reversal is due to a retroactive disenrollment.
N688Alert: This reversal is due to a medical or utilization review decision.
N689 This reversal is due to a retroactive rate change.
N690This reversal is due to a provider submitted appeal.
N691This reversal is due to a patient submitted appeal.
N692 This reversal is due to an incorrect rate on the initial adjudication.
N693 This reversal is due to a cancellation of the claim by the provider.
N694 This reversal is due to a resubmission/change to the claim by the provider.
N695 This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
N696Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
N697Alert: This reversal is due to a payer’s retroactive contract incentive program adjustment.
N698Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage.
N699Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
N700Payment adjusted based on the Electronic Health Records (EHR) Incentive Program.
N701Payment adjusted based on the Value-based Payment Modifier.
N702Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.
N703This service is incompatible with previously adjudicated claims or claims in process.
N704Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.
N705Incomplete/invalid documentation.
N706Missing documentation.
N707Incomplete/invalid orders.
N708Missing orders.
N709Incomplete/invalid notes.
N710Missing notes.
N711Incomplete/invalid summary.
N712Missing summary.
N713Incomplete/invalid report.
N714Missing report.
N715Incomplete/invalid chart.
N716Missing chart.
N717Incomplete/Invalid documentation of face-to-face examination.
N718Missing documentation of face-to-face examination.
N719Penalty applied based on plan requirements not being met.
N720Alert: The patient overpaid you. You may need to issue the patient a refund for the difference between the patient’s payment and the amount shown as patient responsibility on this notice.
N721This service is only covered when performed as part of a clinical trial.
N722Patient must use Workers’ Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
N723Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.
N724Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.
N725A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
N726A conditional payment is not allowed.
N727A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
N728A workers’ compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
N729Missing patient medical/dental record for this service.
N730Incomplete/invalid patient medical/dental record for this service.
N731Incomplete/Invalid mental health assessment.
N732Services performed at an unlicensed facility are not reimbursable.
N733Regulatory surcharges are paid directly to the state.
N734The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.
N736Incomplete/invalid Sleep Study Report.
N737Missing Sleep Study Report.
N738Incomplete/invalid Vein Study Report.
N739Missing Vein Study Report.
N740The member’s Consumer Spending Account does not contain sufficient funds to cover the member’s liability for this claim/service.
N741This is a site neutral payment.
N743Adjusted because the services may be related to an employment accident.
N744Adjusted because the services may be related to an auto/other accident.
N745Missing Ambulance Report.
N746Incomplete/invalid Ambulance Report.
N747This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides.
N748Adjusted because the related hospital charges have not been received.
N749Missing Blood Gas Report.
N750Incomplete/invalid Blood Gas Report.
N751Adjusted because the patient is covered under a Medicare Part D plan.
N752Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC).
N753Missing/incomplete/invalid Attachment Control Number.
N754Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form.
N755Missing/incomplete/invalid ICD Indicator.
N756Missing/incomplete/invalid point of drop-off address.
N757Adjusted based on the Federal Indian Fees schedule (MLR).
N758Adjusted based on the prior authorization decision.
N759Payment adjusted based on the National Electrical Manufacturers Association (NEMA)
N760This facility is not authorized to receive payment for the service(s).
N761This provider is not authorized to receive payment for the service(s).
N762This facility is not certified for Tomosynthesis (3-D) mammography.
N763The demonstration code is not appropriate for this claim; resubmit without a demonstration code.
N764Missing/incomplete/invalid Hematocrit (HCT) value.
N765This payer does not cover coinsurance assessed by a previous payer.
N766This payer does not cover co-payment assessed by a previous payer.
N767The Medicaid state requires provider to be enrolled in the member’s Medicaid state program prior to any claim benefits being processed.
N768Incomplete/invalid initial evaluation report.
N769A lateral diagnosis is required.
N770The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.
N771Alert: Under Federal law you cannot charge more than the limiting charge amount.
N772Alert: Rebill urgent/emergent and ancillary services separately.
N773Drug supplied not obtained from specialty vendor.
N774Alert: Refer to your Third Party Processor Agreement for specific information on fees associated with this payment type.
N775Payment adjusted based on x-ray radiograph on film.
N776This service is not a covered Telehealth service.
N777Missing Assignment of Benefits Indicator.
N778Missing Primary Care Physician Information.
N779Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received.
N780Missing/incomplete/invalid end therapy date.
N781Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer.
N782Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer.
N783Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected copayment. This amount may be billed to a subsequent payer.
N784Missing comprehensive procedure code.
N785Missing current radiology film/images.
N786Benefit limitation for the orthodontic active and/or retention phase of treatment.
N787Alert: Under 42 CFR 410.43, an eligible Partial Hospitalization Program (PHP) patient/beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP services must be furnished in accordance with the plan of care.
N788Alert: The third-party administrator/review organization did not receive the required information.
N789Clinical Trial is not a covered benefit.
N790Provider/supplier not accredited for product/service.
N791Missing history & physical report.
N792Incomplete/invalid history & physical report.
N794Payment adjusted based on type of technology used.
N795Item must be resubmitted as a purchase.
N796Missing/incomplete/invalid Hemoglobin (Hb or Hgb) value.
N797Missing/incomplete/invalid date qualifier.
N798Submit a void request for the original claim and resubmit a new claim.
N799Submitted identifier must be an individual identifier, not group identifier.
N800Only one service date is allowed per claim.
N801Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation 42 CFR 136.
N802This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located.
N803Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital.
N804Alert: The claim/service was processed through the Outpatient Code Editor (OCE).
N805Alert: The claim/service was processed through the Correct Code Editor (CCE).
N806Payment is included in the Global transplant allowance.
N807Payment adjustment based on the Merit-based Incentive Payment System (MIPS).
N808Not covered for this provider type / provider specialty.
N809Alert: The fee schedule amount for this service was adjusted based on prior competitive bidding rates. For more information, contact your local contractor.
N810Alert: Due to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit. At the conclusion or expiration of the disaster declaration, network payment rules will be reinstated.
N811Missing Federal Sequestration Reduction from Prior Payer.
N812The Started on service date through end service date cannot span greater than 18 months.
N815Missing/Incomplete/Invalid NDC Unit Count
N816Missing/Incomplete/Invalid NDC Unit of Measure
N817Alert: Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 – March 31, 2020.
N818Claims Dates of Service do not match Electronic Visit Verification System.
N819Patient not enrolled in Electronic Visit Verification System.
N820Electronic Visit Verification System units do not meet requirements of visit.
N821Electronic Visit Verification System visit not found.
N822Missing procedure modifier(s).
N823Incomplete/Invalid procedure modifier(s).
N824Electronic Visit Verification (EVV) data must be submitted through EVV Vendor.
N825Early intervention guidelines were not met.
N826Patient did not meet the inclusion criteria for the Medicare Shared Savings Program.
N827Missing/Incomplete/Invalid Federal Information Processing Standard (FIPS) Code.
N828Alert: Payment is suppressed due to a contracted funding.
N829Missing/incomplete/invalid Diagnostics Exchange Z-Code Identifier.
N830Alert: The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations. As such, any amount identified with OA, CO, or PI cannot be collected from the member and may be considered provider liability or be billable to a subsequent payer. Any amount the provider collected over the identified PR amount must be refunded to the patient within applicable Federal/State timeframes. Payment amounts are eligible for dispute pursuant to any Federal/State documented appeal/grievance process(es).
N831You have not responded to requests to revalidate your provider/supplier enrollment information.
N832Duplicate occurrence code/occurrence span code.
N833Patient share of cost waived.
N834Jurisdiction exempt from sales and health tax charges.
N835Unrelated Service/procedure/treatment is reduced. The balance of this charge is the patient’s responsibility.
N836Provider W9 or Payee Registration not on file.
N837Alert: Missing modifier was added.
N838Alert: Service/procedure postponed due to a federal, state, or local mandate/disaster declaration. Any amounts applied to deductible or member liability will be applied to the prior plan year from which the procedure was cancelled.
N839The procedure code was added/changed because the level of service exceeds the compensable condition(s).
N840Worker’s compensation claim filed with a different state.
N841North Dakota Administrative Rule 92-01-02-50.3.
N842Patient cannot be billed for charges.
N843Missing/incomplete/invalid Core-Based Statistical Area (CBSA) code.
N844This claim, or a portion of this claim, was processed in accordance with the Nebraska Legislative LB997 July 24, 2020 – Out of Network Emergency Medical Care Act.
N845Alert: Nebraska Legislative LB997 July 24, 2020 – Out of Network Emergency Medical Care Act.
N846National Drug Code (NDC) supplied does not correspond to the HCPCs/CPT billed.
N847National Drug Code (NDC) billed is obsolete.
N848National Drug Code (NDC) billed cannot be associated with a product.
N849Missing Tooth Clause: Tooth missing prior to the member effective date.
N850Missing/incomplete/invalid narrative explaining/describing this service/treatment.
N851Payment reduced because services were furnished by a therapy assistant.
N852The pay-to and rendering provider tax identification numbers (TINs) do not match.
N853The number of modalities performed per session exceeds our acceptable maximum.
N854Alert: If you have primary other health insurance (OHI) coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbursement.
N855This coverage is subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.
N856This coverage is not subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.
N857This claim has been adjusted/reversed. Refund any collected copayment to the member.
N858Alert: State regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim. Payment amounts are eligible for dispute following the state’s documented appeal/ grievance/ arbitration process.
N859Alert: The Federal No Surprise Billing Act was applied to the processing of this claim. Payment amounts are eligible for dispute pursuant to any Federal documented appeal/ grievance/ dispute resolution process(es).
N860Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).
N861Alert: Mismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient.
N862Alert: Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge.
N863Alert: This claim is subject to the No Surprises Act (NSA). The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA.
N864Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.
N865Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating facility.
N866Alert: This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services.
N867Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.
N868Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
N869Alert: Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act.
N870Alert: In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount.
N871Alert: This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act.
N872Alert: This final payment was calculated based on a specified state law, in accordance with the No Surprises Act.
N873Alert: This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
N874Alert: This final payment was determined through open negotiation, in accordance with the No Surprises Act.
N875Alert: This final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act.
N876Alert: This item or service is covered under the plan. This is a notice of denial of payment provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate than the amount paid by the patient in cost sharing.
N877Alert: This initial payment is provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate.
N878Alert: The provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and obtained in a manner consistent with applicable Federal law. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.
N879Alert: The notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the billed services, is not permitted for these services. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.
N880Original claim closed due to changes in submitted data. Adjustment claim will be processed under a new claim number.
N881Client Obligation, patient responsibility for Home & Community Based Services (HCBS)
N882Alert: The out-of-network payment and cost sharing amounts were based on the plan’s allowance because the provider or facility obtained the patient’s consent to waive the balance billing protections under the No Surprises Act.
N883Alert: Processed according to state law
N884Alert: The No Surprises Act may apply to this claim. Please contact payer for instructions on how to submit information regarding whether or not the item or service was furnished during a patient visit to a participating facility.
N885Alert: This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those requirements apply. You may contact the payer to find out why it disagrees. You may appeal this adverse determination on behalf of the patient through the payer’s internal appeals and external review processes.
N886Alert: A Health Care Claim Request for Additional Information (277 RFAI) has been sent.
N887Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not paid the services at the expected Medicare reimbursable rate or type of level/service. Providers may file their appeal in writing within 60 calendar days after the date of the remittance advice. For the plan to review the appeal, the plan will need a completed signed Waiver of Liability Statement. To obtain a Waiver of Liability form, please contact your Medicare Advantage Plan.

Once we receive the completed forms, we will give you a decision on your appeal within 60 calendar days.
N888Alert: An electronic request for additional information has been sent for this claim.

In conclusion, Claim Adjustment Reason Codes (CARC Codes) play a pivotal role in the healthcare industry by offering a standardized and clear method for explaining the adjustments made to medical claims. These three-digit codes provide crucial insights into why a claim has been paid differently than billed, facilitating effective communication between healthcare providers and insurance payers. By utilizing CARCs, healthcare professionals can navigate the complexities of claims processing, identify discrepancies, and take appropriate actions to rectify issues.

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Expert at medical billing and RCM
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The author and contributor of this blog "NSingh" is working in Medical Billing and Coding since 2010. He is MBA in marketing and Having vaste experience in different scopes of Medical Billing and Coding as AR-Follow-up, Payment Posting, Charge posting, Coding, etc.