MA55Remark Code (RARC)Active
MA55 Remark Code - Coverage Denied for Care Election
The MA55 remark code indicates that the claim is not covered because the patient received medical health care services, which automatically revokes their election to receive religious non-medical health care services. This suggests that the payer has determined the services billed conflict with the patient's prior election regarding their healthcare choices.
How It Relates to the Denial
The MA55 remark code typically accompanies a Claim Adjustment Reason Code that reflects a denial based on the patient's election of non-medical health care services. This combination signals that the services rendered are not payable due to the patient's choice of care.
Common Scenarios
1A patient who had previously chosen religious non-medical health care services is billed for a routine medical exam. The remittance shows the MA55 remark code.
→ In this case, the MA55 remark code points out that because the patient received medical services, it invalidated their prior election for non-medical care, leading to a denial of coverage.
2A claim for laboratory tests is submitted for a patient who opted for religious non-medical services. The remittance returns with a denial and the MA55 remark code.
→ The MA55 remark code indicates that the payer finds the laboratory services not covered, as the patient's choice to receive medical care nullifies their election for non-medical services.
3A patient receives physical therapy treatments after electing religious non-medical health care. The submitted claims return with an adjustment and include the MA55 remark code.
→ Here, the MA55 remark code clarifies that the physical therapy services are not covered because the patient's engagement in medical treatment has revoked their prior election for non-medical services.
What to Do
- Review the patient's election status regarding health care services.
- Ensure that any future claims align with the patient's current care preferences.
- Communicate with the patient to clarify their choices and obtain necessary consent for medical services.
What to Check
- The patient's election documentation regarding religious non-medical health care services.
- The claim's details to confirm the services billed were indeed medical in nature.
- The payer's policy on coverage for patients with dual elections of care types.