M39Remark Code (RARC)ActiveInformational Alert
M39 Remark Code - Patient Not Liable for Payment Alert
The M39 alert indicates that the patient is not responsible for payment for a specific service because the advance notice of non-coverage provided did not meet required program standards. This alert serves to inform the provider that liability for the payment does not rest with the patient due to compliance issues with the notice.
What This Alert Tells You
The M39 alert is informational and does not accompany any specific adjustment or denial reason code. It highlights potential issues with the advance notice of non-coverage requirements that may affect billing practices.
Common Scenarios
1A provider submits a claim for a procedure performed on a patient and receives an 835/ERA showing the M39 alert.
→ This alert indicates that the advance notice of non-coverage given to the patient was not compliant with program requirements, absolving the patient from payment responsibility.
2A billing office reviews a claim for a service that was billed to a patient who was later informed about non-coverage, only to find the M39 alert on the remittance advice.
→ The alert points to a failure in the advance notice process, meaning the patient shouldn't be billed for the service based on the non-compliance of the notice.
3A facility receives an M39 alert after billing for a service that traditionally requires advance notice of non-coverage, but the patient was not held liable for payment.
→ The M39 alert indicates that the advance notice provided did not comply with the necessary program guidelines, thus protecting the patient from payment liability.
What to Do
- Do not take any action to resubmit the claim based on this alert, as it does not indicate a denial that requires correction.
- Consider reviewing your processes regarding advance notice of non-coverage to ensure compliance with program requirements.
What to Check
- Review the advance notice of non-coverage documentation provided to the patient for compliance with program standards.
- Check the patient's eligibility and benefit details to confirm the requirements for non-coverage notifications.
- Examine the claim submission details to ensure that all required notices were appropriately issued prior to the service provided.