M116Remark Code (RARC)Active
M116 Remark Code - Demonstration Project Ending
The M116 remark code indicates that the claim has been processed under a demonstration project or program that is concluding. As a result, any additional services billed under this project or program will not receive payment.
How It Relates to the Denial
This remark typically accompanies a Claim Adjustment Reason Code (CARC) that reflects an adjustment due to services being rendered under a specific demonstration project. The combination signals that the project is ending, impacting further claims for services provided under that project.
Common Scenarios
1A provider submits claims for a series of services rendered under a Medicare demonstration project. The remittance advice shows an adjustment for these services along with the M116 remark.
→ In this case, M116 clarifies that the adjustment is due to the conclusion of the demonstration project, meaning no further services under this program will be reimbursed.
2An outpatient facility bills for physical therapy services covered under a state-funded demonstration program. The payment response includes a denial for the last service submitted, with the M116 remark noted.
→ Here, M116 signifies that the program funding has ended, and any further services will not be eligible for payment, as indicated by the accompanying adjustment.
3A hospital submits claims for various diagnostic tests performed as part of a clinical trial. The remittance advises that payments are adjusted, citing the M116 remark code.
→ The M116 remark indicates that these tests were processed under a demonstration program that is ending, which affects the payment eligibility for those services.
What to Do
- Review the associated Claim Adjustment Reason Code to understand the specific adjustment applied.
- Do not resubmit claims for additional services under the ended demonstration project, as they will not be paid.
- Consider alternative funding sources or programs for future service claims.
What to Check
- Verify the details of the demonstration project or program referenced in the adjustment.
- Check the eligibility response for the patient to confirm coverage under the demonstration project.
- Consult the payer's policy on the demonstration project to understand the implications of its ending.