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MIR-2006-9AB, September 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update (CR5212)
Provider Types Affected
Providers, physicians, and suppliers who bill Medicare fiscal intermediaries (FIs), including regional home health intermediaries (RHHIs), Medicare carriers, including durable medical equipment regional carriers (DMERCs) and Durable Medical Equipment Medicare Administrative Contracts (DME MACs)
Provider Action Needed
Impact to You
The November 2005 through February 2006 updates have been posted for the X12N 835 Health Care Remittance Advice Remark Codes (RARCs) and the X12N 835 Health Care Claim Adjustment Reason codes (CARCs).
What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) has developed a new Web site located at http://www.cmsremarkcodes.info/  on the CMS Web site, to provide information and help navigate the RARC database more easily. A helpful search tool is provided at this site if you need to find a specific category of code. This new Web site does not replace the Washington Publishing Company (WPC) Web site, http://www.wpc-edi.com/codes, as the official site where the most current RARC list resides. Use the list posted at the WPC Web site if there are any discrepancies between code text listed either on the new Web site or in this article, and the code text provided on the WPC Web site.
What You Need to Do
Please refer to the Background section of this article for a summary of the RARC and CARC code text changes.
Background
Among the codes sets mentioned in the Implementation Guide for transaction 835 (Health Care Claim Payment/Advice), the following two code sets must be used to report payment adjustments and related information for transaction 835 and the standard paper remittance advice for Medicare:
- Claim Adjustment Reason Code (CARC); and
- Remittance Advice Remark Code (RARC).
Additionally, for the coordination of benefits (COB) transaction (837), the CARC must be used.
Both of these code sets are updated three times a year, and Medicare issues recurring Change Requests (CRs) that capture the changes in these code sets that have been approved in the previous four months.
Summary of Current Updates (November 1, 2005 – February 28, 2006 Changes)
Remark Code (RARC) Changes
New: The following code table reflects new remark codes:
| New Code |
Current Narrative |
N365 |
This procedure code is not payable. It is for reporting/information purposes only. |
N366 |
Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice. |
N367 |
The claim information has been forwarded to a Health Savings Account processor for review. |
N368 |
You must appeal the determination of the previously adjudicated claim. |
N369 |
Alert: Although this claim has been processed, it is deficient according to state legislation/regulation. |
Modified : Remark Code MA02 was modified effective December 29, 2005. Its modified narrative is:
“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. Decisions made by a Quality Improvement Organization (QIO) must be appealed to that QIO within 60 days.”
This modification is effective January 1, 2006, and was implemented on or before May 17, 2006.
Deactivated : Code MA03 was deactivated effective October 1, 2006. Remark code MA02 may be used instead.
Reason Code (CARC) Changes
New : The following table reflects new reason codes:
| New Code |
Current Narrative |
New as of: |
193 |
Original payment decision is being maintained. This claim was processed properly the first time. |
February 2006 |
194 |
Payment adjusted when anesthesia is performed by the operating physician, the assistant surgeon, or the attending physician. |
February 2006 |
195 |
Payment denied/reduced due to a refund issued to an erroneous priority payer for this claim/service. |
February 2006 |
Implementation Date
These code changes will be applied by your Medicare carrier/DMERC/FI/RHHI by October 2, 2006.
Additional Information
CR5212 is the official instruction issued to your Medicare carrier/DMERC/FI/RHHI regarding changes mentioned in this article. CR5212 may be found at http://www.cms.hhs.gov/Transmittals/downloads/R1031CP.pdf  on the CMS Web site.
For more information on the process used to update these two codes sets, see the MLN Matters article, MM44314, available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4314.pdf on the CMS Web site.
If you have questions please contact your local Medicare carrier/DMERC/FI/RHHI at their toll-free number, which may be found at Number: MM5212 Related Change Request Number: 5212
http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5212
Pub. 100-4, Transmittal# R1031CP, CR# 5212
Related CR Release Date: August 18, 2006
Effective Date: October 1, 2006
Implementation Date: October 2, 2006
Attention Physicians and Providers!
Effective October 1, 2006, Medicare will only generate Health Insurance Portability and Accountability Act (HIPAA)-compliant remittance advice—transaction 835 version 004010A1—to all electronic remittance advice receivers. For more details, see MLN Matters article SE0656 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SEO656.pdf. Get your Medicare news as it happens!
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