M86Remark Code (RARC)Active
M86 Remark Code - Service Denied for Prior Payment
The M86 remark code indicates that the service was denied because a payment has already been made for the same or a similar procedure within a specified time frame. This remark serves as additional information to clarify the adjustment made by the accompanying reason code, signaling that the claim is not eligible for reimbursement due to prior payment.
How It Relates to the Denial
The M86 remark typically accompanies a claim adjustment reason code that denotes a denial based on previous payments. This combination indicates that the payer has determined the billed service is not payable due to an earlier payment for a similar service, reinforcing the initial denial reason.
Common Scenarios
1A provider submits a claim for a surgical procedure performed on a patient, but the remittance shows the M86 remark code alongside a reason code indicating a denial due to prior payment.
→ In this case, the M86 remark tells you that the payer has already compensated for a similar surgical procedure for the same patient within the allowed time frame, leading to this denial.
2A physical therapy claim is submitted for a patient who received therapy sessions earlier in the month. The remittance returns with an adjustment reason code for denial and includes the M86 remark.
→ Here, the M86 remark indicates that the patient was already paid for similar therapy services recently, thus justifying the denial of the current claim due to overlapping services.
3A claim for a diagnostic test is denied with an accompanying reason code that indicates it has been previously reimbursed. The remittance includes the M86 remark code.
→ The M86 remark clarifies that the test has already been paid for within the specified time frame, explaining the denial further.
What to Do
- Review the claim details to confirm if the same or similar procedure was billed previously within the designated time frame.
- Check if the patient has had overlapping services that could lead to this denial and adjust future submissions accordingly.
- Consider reaching out to the payer for clarification on their specific time frame for similar procedures if needed.
What to Check
- The patient's claims history for the same or similar procedures to validate the payment timing.
- The remittance advice for any previous payments made for similar services to understand the denial context.
- The claim submission date in relation to the previous payment date for the same service to ensure compliance with the payer's policy.