M117Remark Code (RARC)Active
M117 Remark Code - Not Covered Unless Electronic Claim
The M117 remark code indicates that the billed service is not covered unless it was submitted through an electronic claim. This means that if the claim was submitted via paper, the payer will not provide reimbursement for that service.
How It Relates to the Denial
The M117 code typically accompanies a Claim Adjustment Reason Code that signals a denial or adjustment based on submission method. It reinforces the need for electronic submission for coverage eligibility.
Common Scenarios
1A provider submitted a claim for a diagnostic service via paper and received a denial on the remittance with the accompanying reason code indicating non-coverage.
→ The M117 remark clarifies that the service is only covered if the claim is submitted electronically, pointing to a need for resubmission in the correct format.
2A physical therapy claim was submitted on a paper claim form and the remittance returned with a denial stating the service is not covered.
→ The presence of M117 indicates that the payer requires electronic submission for this service to be eligible for reimbursement.
3A laboratory test claim was denied with a reason code referring to non-coverage, and M117 was included in the remittance advice.
→ This remark suggests that the laboratory test will only be covered if the claim was submitted electronically, suggesting a necessary step to correct the submission method.
What to Do
- Resubmit the claim electronically to ensure coverage.
- Verify that the electronic claim submission meets the payer's specific requirements.
What to Check
- The original claim submission method to confirm if it was paper-based.
- The payer's guidelines for electronic claim submissions.
- Any specific documentation required for electronic submissions.