M40Remark Code (RARC)Active
M40 Remark Code - Claim Must Be Employer Filed
The M40 remark code indicates that the claim must be assigned to and filed by the practitioner’s employer. This suggests that the current submission does not meet this requirement, which could lead to denial or adjustment.
How It Relates to the Denial
Typically, the M40 remark accompanies adjustment reason codes related to claim submission errors or assignment issues. The combination signals that the payer expects the claim to be submitted in accordance with employer assignment rules.
Common Scenarios
1A provider submits a claim for a service rendered while the practitioner is an independent contractor, not an employee of the billing entity. The remittance shows an adjustment with the M40 remark code.
→ In this case, the M40 remark indicates that the claim was not appropriately assigned to the practitioner’s employer, which is necessary for proper processing.
2A claim is filed for a procedure performed by a physician who is listed as an independent practitioner rather than as an employee of the facility. The remittance response includes the M40 remark code with an adjustment reason code for claim denial.
→ Here, the M40 remark highlights that the claim must have been filed by the physician's employer, pointing out the misalignment with the payer's requirements.
3A facility submits a claim for services rendered by a physician who has an employment agreement with them, but the claim is incorrectly filed under the physician's individual NPI. The remittance includes the M40 remark.
→ This scenario shows that the M40 remark is addressing the need for the claim to be filed under the employer's name, indicating a submission error that needs correction.
What to Do
- Verify that the claim was submitted under the correct employer's name and NPI.
- Ensure that the practitioner is indeed an employee of the billing entity at the time of service.
- If necessary, refile the claim under the appropriate employer's information.
What to Check
- The employment status of the practitioner at the time of service.
- The claim submission details, including the NPI and billing entity name.
- The payer's policy regarding claim assignments to ensure compliance.