Remittance Advice Remark Codes (RARC)
1137 active remark codes across the M, MA, and N series — each page decodes what the remark is pointing at, realistic scenarios, and exactly what to supply or correct. Informational "Alert" codes are flagged on their pages.
MA Series (110)
MA01 ℹAppeal Process InformationMA02 ℹAppeal Right AlertMA04Missing Primary Payer InformationMA07 ℹClaim Forwarded to Medicaid AlertMA08 ℹClaim Information Not ForwardedMA09 ℹClaim Processed as AssignedMA10 ℹPatient Overpayment AlertMA12Billing Authority IssuesMA13 ℹPatient Billing Penalty AlertMA14 ℹEmployer-Sponsored Plan AlertMA15 ℹClaim Handling AlertMA16Patient Covered by Black Lung ProgramMA17Primary Payer NotificationMA18 ℹClaim Forwarded to Supplemental InsurerMA19 ℹMedigap Information AlertMA20Skilled Nursing Facility Coverage IssuesMA21SSA Mismatch ExplanationMA22Payment Less Than $1.00 SuppressedMA23Demand Bill ApprovedMA24Christian Science Sanitarium/SNF BillingMA25Hospice Provider Change LimitationMA26 ℹInformational Alert on Previous RulesMA27Missing Entitlement Info ExplainedMA28 ℹInformational Alert for ProvidersMA30Missing or Invalid Type of BillMA31Missing or Invalid Dates ExplanationMA32Missing Covered Days ExplainedMA33Missing/Invalid Non-Covered DaysMA34Missing Coinsurance Days ExplanationMA35Missing Lifetime Reserve Days ExplainedMA36Missing Patient Name ExplainedMA37Missing Patient's Address ExplainedMA39Missing Gender InformationMA40Missing Admission Date ExplainedMA41Missing Admission Type ExplainedMA42Missing Admission Source ExplainedMA43Missing Patient Status ExplainedMA44 ℹNo Appeal Rights AlertMA45 ℹPayment Held AlertMA46 ℹNo Additional Payment IssuedMA47Medicare Opt-Out ExplanationMA48Missing/Invalid Responsible Party InfoMA50Investigational Device or Clinical Trial NumberMA53Competitive Bidding ID IssueMA54Hospice Care Certification TimelinessMA55Coverage Denied for Care ElectionMA56Medicare Opt-Out ExplanationMA57Patient Revoked Religious Care ElectionMA58Release of Information Indicator IssueMA59 ℹPatient Overpayment AlertMA60Patient Relationship IssuesMA61Missing Social Security NumberMA62 ℹTelephone Review Decision AlertMA63Missing Principal Diagnosis ExplanationMA64Third Payer Processing DelayMA65Missing/Incompleted Admitting DiagnosisMA66Missing/Invalid Procedure CodeMA67 ℹCorrection to Prior Claim AlertMA68 ℹIncomplete Secondary Insurance InfoMA69Missing/Incomplete/Invalid RemarksMA70Missing Provider Signature ExplanationMA71Signature Date Issue ExplainedMA72 ℹPatient Overpayment AlertMA73Medicare Demonstration InformationalMA74 ℹPayment Replacement AlertMA75Missing Patient Signature ExplainedMA76Incomplete Provider IdentifierMA77 ℹPatient Overpayment AlertMA79Billed in Excess of Interim RateMA80No Payment Issued for ClaimMA81Missing/Invalid Provider SignatureMA83Payer Status Not IndicatedMA84Emphysema Treatment Trial ParticipationMA88Insured's Address/Phone MissingMA89Patient's Relationship MissingMA90Employment Status Code IssueMA91 ℹAppeal Determination AlertMA92Missing Plan InformationMA93Non-PIP Claim ExplainedMA94Missing Hospice Employment StatementMA96Claim Rejected for Enrollment IssueMA97Medicare Contract Number IssuesMA99Medigap Information IssuesMA100Missing Date of Current IllnessMA103Hemophilia Add On ExplainedMA106PIP Claim ExplanationMA107Claim Field 19 IssuesMA108Field 23 Data Item ErrorMA109Ambulatory Surgical Guidelines InsightMA110Missing Diagnostic Test InfoMA111Purchase Price and Lab Info IssuesMA112Missing Group Practice InfoMA113TIN Incomplete/InvalidMA114Missing Service Location InfoMA115Missing HPSA Location InfoMA116Homebound Status ValidationMA117User Fee ExplainedMA118 ℹNo Medicare Payment for VA ServicesMA120Missing CLIA Certification NumberMA121Missing X-Ray Date ExplainedMA122Missing Initial Treatment DateMA123Non-Participation in StudyMA125Payment in Full ExplainedMA126Pancreas Transplant CoverageMA128Missing FDA Approval Number ExplanationMA130Incomplete Claim InformationMA131Payment Already Made for ServicesMA132Adjustment to Pre-Demonstration RateMA133Overlapping Inpatient Stay GuidanceMA134Provider Number Issues
M Series (122)
M1X-ray Timing RequirementM2Not Paid Separately for InpatientsM3Equipment Similarity ExplanationM4 ℹLast DME Installment Payment AlertM5Rental Payment Duration ExplainedM6 ℹService Requirement AlertM7No Rental Payments AllowedM8Blood Gas Test Acceptance CriteriaM9 ℹInform Patient on Rental Purchase OptionM10Equipment Purchase Timing RestrictionsM11DME Billing Requirements ExplainedM12Diagnostic Test Service InclusionM13Initial Visit Coverage LimitM14Injection Payment Denial ExplanationM15Bundled Services ExplainedM16 ℹInformational Alert for ProvidersM17 ℹPayment Approved AlertM18Home Use Eligibility ExplainedM19Missing Oxygen CertificationM20Missing/Invalid HCPCS ExplainedM21Missing Residence Info for Home ServicesM22Missing/Incomplete MileageM23Missing Invoice ExplainedM24Missing/Invalid Doses per VialM25Service Level Not SupportedM26Service Level Documentation IssuesM27 ℹLiability Relief AlertM28Part B Payment QualificationM29Missing Operative Note/ReportM30Missing Pathology ReportM31Missing Radiology Report ExplanationM32 ℹConditional Payment AlertM36Rental Month Payment HoldM37Not Covered Under Age 35M38 ℹPatient Liability AlertM39 ℹPatient Not Liable for Payment AlertM40Claim Must Be Employer FiledM41Patient Not Legally Obligated to PayM42Physician Signature RequiredM44Missing Condition Code ExplanationM45Missing/Invalid Occurrence CodesM46Missing/Invalid Occurrence Span CodesM47Missing Payer Claim Control NumberM49Missing or Invalid Value CodesM50Missing Revenue Codes ExplainedM51Missing or Invalid Procedure CodesM52Missing or Invalid Service DatesM53Missing/Incomplete/Invalid Days or UnitsM54Missing Total Charges ExplainedM55Self-Administered Anti-Emetics DenialM56Missing Payer Identifier ExplainedM59Missing/Invalid 'To' DateM60Missing Certificate of Medical NecessityM61FDA Clinical Trial Approval ExpiredM62Missing Treatment Authorization CodeM64Missing/Invalid Other DiagnosisM65One Charge Per Claim RuleM66Diagnostic Tests Price LimitationsM67Missing Procedure Codes ExplainedM69Documentation Insufficient for Modified CodeM70 ℹAlert on NDC Code SubmissionM71Total Payment Reduced for OverlapM73HPSA Bonus Payment GuidanceM74HPSA/Physician Scarcity Bonus IneligibleM75Multiple Tests Combined for PaymentM76Missing/Incomplete DiagnosisM77Place of Service IssuesM79Missing/Invalid Charge ExplainedM80Not Covered When Performed TogetherM81Highest Level of Specificity RequiredM82Service Not Covered Under Age 50M83Service Not Covered Without High RiskM84Medical Code Sets ComplianceM85Review of Evaluation and Management ServicesM86Service Denied for Prior PaymentM87CFO-CAP Prepayment Review ExplanationM89Not Covered More Than Once Under Age 40M90Not Covered More Than OnceM91Lab Procedures Billing GuidelinesM93Break in Therapy and Rental PeriodM94Break in Therapy Not SupportedM95Home Health Initiative ReviewM96Technical Component Billing RulesM97Not Paid to Practitioner ExplanationM99Missing/Invalid Product NumberM100Oral Anti-Emetic Drug CoverageM102Service Not Performed on FDA Approved EquipmentM103Break in Therapy Payment AdjustmentM104Break in Therapy ExplainedM105Break in Therapy Not SupportedM107Payment Reduced for ESRD HematocritM109Bundled Payment for TeleconsultationM111Chiropractic Treatment Denial ExplanationM112DMEPOS Competitive Bidding PaymentM113DMEPOS Competitive Bidding IssueM114DMEPOS Competitive Bidding InfoM115Denial for Non-Contract SupplierM116Demonstration Project EndingM117Not Covered Unless Electronic ClaimM119NDC Issues ExplainedM121Coverage with Cryosurgical AblationM122Missing Subluxation Level ExplainedM123Drug Information Issues ExplainedM124Patient Equipment Ownership MissingM125Missing Duration InformationM126Missing Lab Codes ExplainedM127Missing Patient Medical RecordM129X-ray Availability Indicator IssueM130Missing Invoice for Intraocular LensM131Missing Physician Financial Relationship FormM132Missing Pacemaker Registration FormM133Missing Diagnostic Test InfoM134Financial Interest in Facility/SupplierM135Missing Treatment Plan DetailsM136Physician Supervision RequiredM137Part B Coinsurance ExplanationM138Patient Not Enrolled in DemonstrationM139Coverage Limit Denial ExplanationM141Missing Physician Certified Plan of CareM142Missing Diabetes CertificationM143Update License Information NeededM144Pre-/Post-Operative Care Payment
N Series (905)
N1 ℹAppeal Options AvailableN2Treatment Provision AllowanceN3Missing Consent Form ExplainedN4Missing Insurance Carrier EOBN5EOB Received, Claim Not on FileN6Payment Limit Under FEHB LawN7 ℹMajor Medical Provisions AlertN8Claim Data IncompleteN9Estimated Previous Payer AmountN10Adjustment Based on Review FindingsN11Denial Reversed via Medical ReviewN12Medicare Enrollment ResponsibilityN13Payment Based on ModifiersN15Services for Newborn Must Be Billed SeparatelyN16Out-of-Pocket Maximum MetN19Procedure Code Incidental to Primary ProcedureN20Service Not Payable with Other ServiceN21 ℹAlert for Line Item SeparationN22 ℹProcedure Code Update AlertN23 ℹPatient Liability AlertN24EFT Banking Info IssuesN25Administrative Claims Payment ServicesN26Missing Itemized Bill/StatementN27Missing Treatment Number ExplainedN28Consent Form Requirements Not FulfilledN30Patient Ineligible for ServiceN31Missing Prescribing Provider IdentifierN32Claim Submission by Rendering ProviderN33No Health Check Record Before TreatmentN34Incorrect Claim Form/FormatN35Program Integrity Decision ExplainedN36Processing Requirements Not MetN37Missing Tooth Number ExplanationN39Procedure Code IncompatibilityN40Missing Radiology FilmsN42Missing Mental Health AssessmentN43Bed Hold or Leave Days ExceededN45Payment Based on Authorized AmountN46Missing Admission Hour ExplainedN47Conflicting Inpatient Stay ExplainedN48Claim Information DiscrepancyN49Coverage Information Validation NeededN50Missing Discharge Information ExplainedN51Electronic Interchange Agreement IssueN52Patient Not Enrolled in Managed Care PlanN53Missing Point of Pick-Up AddressN54Claim Info Inconsistent with AuthorizationN55Billing Procedures Not FollowedN56Procedure Code InvalidN57Missing Prescribing Date ExplanationN58Missing Patient Liability AmountN59 ℹInformational Alert for ProvidersN61Rebill Services on Separate ClaimsN62Dates of Service Span Multiple Rate PeriodsN63Rebill Services on Separate Claim LinesN64Dates Must Be DifferentN65Procedure Code Not FoundN67Professional Services Not Separately PaidN68Payment Cancellation Due to CoverageN69 ℹPPS Code Changed AlertN70Consolidated Billing GuidanceN71Claim Assignment Requirement ExplainedN72PPS Code Changed by ReviewersN74Resubmit Claims by MonthN75Missing Tooth Surface InformationN76Missing Number of Riders ExplainedN77Missing/Invalid Provider NumberN78EPSDT Components Not CompletedN79Patient Location Compatibility IssueN80Missing Prenatal Screening InfoN81Procedure Not Compatible with Tooth SurfaceN82Insurance Payment in Full RequirementN83No Appeal Rights ExplainedN84 ℹFurther Installment Payments ComingN85 ℹFinal Installment Payment AlertN86Coverage Requirement for BiofeedbackN87Home Use of Biofeedback Not CoveredN88 ℹConditional Payment AlertN89 ℹPayment Info Forwarded to Multiple PayersN90Covered Only When Performed by Attending PhysicianN91Services Not Included in Appeal ReviewN92Facility Not Certified for Digital MammographyN93Separate Claims for Each Place of ServiceN94Taxonomy Code Required for AdjudicationN95Provider Type RestrictionsN96Surgical Candidacy and Therapy RequirementsN97Exclusion for Specific ConditionsN98Patient Test Stimulation RequirementN99Patient Diary Documentation RequirementN103Patient in Custody Denial ExplainedN104Claims Jurisdiction Denial ExplainedN105Misdirected Claim for RRB BeneficiaryN106Payment Responsibility for SNF ServicesN107SNF Inpatient Billing GuidanceN108Missing Upgrade InformationN109 ℹClaim Selected for Complex ReviewN110Facility Not Certified for MammographyN111No Appeal Right ExplainedN112Excluded from Electronic Remittance AdviceN113Initial Visit Coverage LimitN114Ambulance Fee Schedule Payment ExplanationN115Local Coverage Determination DecisionN116 ℹConditional Payment AlertN117Lifetime Payment LimitN118Service Not Paid if Billed Too OftenN119Service Not Paid After Inpatient StayN120Home Health Partial Episode Payment AdjustmentN121Medicare Part B SNF DenialN122Add-on Code Cannot Be Billed AloneN123 ℹSplit Service Alert InformationN124Payment Denied for Insufficient DocumentationN125Payment Denied for Insufficient DocumentationN126Deportation Denial ExplanationN127Misdirected Claim for UMWAN128Prior to Coverage AdjustmentN129Patient Age EligibilityN130Consult Benefit DocumentsN131Total Payments Limit ExplainedN132 ℹPayment Alert for Excluded ProvidersN133 ℹServices Processed Separately AlertN134 ℹScheduled Payment AlertN135Patient Responsibility for Record FeesN136 ℹAppeal Process InformationN137 ℹAppeal and Complaint OptionsN138 ℹDental Advisor Review AlertN139 ℹAppeal Process for Non-Participating ProvidersN140 ℹAppeal Rights for OCONUS ProvidersN141Patient Not in Long-Term Care FacilityN142Original Claim DeniedN143Patient Not in Hospice ProgramN144Rate Change During Service DatesN146Missing Screening Document ExplainedN147Patient ID Issues Affecting RateN148Missing Date of Last Menstrual PeriodN149Rebill All Services on One ClaimN150Missing Model Number ExplanationN151Face-to-Face Contact RequirementN152Replacement Claim Information IssuesN153Missing Room and Board Rate ExplainedN154 ℹPayment Delayed for Address CorrectionN155 ℹAlert for Other Insurance InformationN156 ℹPatient Responsibility AlertN157Transportation Not CoveredN158Non-Covered Transportation ServicesN159Mileage Not Covered When Patient Not in AmbulanceN160Patient Choice Required for PaymentN161Coverage Conditional on ServiceN162 ℹLaboratory Certification AlertN163Documentation Support IssuesN167Charges Exceed Post-Transplant LimitN170Certificate of Medical Necessity NeededN171Payment for Repair/Replacement DeniedN172Patient Not Liable for ChargesN173No Hospital Stay Dates ProvidedN174Patient Liability Limited ExplainedN175Missing Review Organization ApprovalN176Services Aboard Ships CoverageN177 ℹNo Additional Payment from Other InsurerN178Missing Pre-Operative ImagesN179Additional Information RequestedN180Criteria Not Met for Billed CategoryN181Additional Information RequiredN182Schedule Billing RequirementN183 ℹPredetermination Advisory MessageN184Rebill Components SeparatelyN185 ℹDo Not Resubmit Claim AlertN186Non-Availability Statement RequiredN187 ℹReview Request InstructionsN188Care Level Mismatch ExplainedN189 ℹOne-time Exception Payment AlertN190Missing Contract Indicator ExplainedN191Update Insurance InformationN192 ℹPatient Medicaid/Qualified Medicare BeneficiaryN193 ℹService Coverage AlertN194Technical Component Payment DenialN195Technical Component Must Be Billed SeparatelyN196 ℹPatient Eligible for Other CoverageN197Update Insurance Info RequiredN198Rendering Provider Affiliation RequiredN199Additional Payment ApprovedN200Professional Component Billing RequirementN202 ℹAdditional Information AlertN203Missing Anesthesia Time/UnitsN204Services Under ReviewN205Information IllegibleN206Documentation Mismatch ExplainedN207Missing Weight ExplanationN208Missing/Invalid DRG CodeN209Missing/Invalid TIN ExplanationN210 ℹYou May Appeal This DecisionN211 ℹYou May Not Appeal This DecisionN212Charges Processed Under POS BenefitN213Missing DRG Information ExplainedN214Surgical History IssuesN215 ℹClaims Determination AlertN216Service Coverage Not OfferedN217One Site of Service per ProviderN218Maintenance and Service RequirementsN219Payment Based on Previous Payer's AmountN220 ℹAlert for Provider Dispute InstructionsN221Missing Admitting History and Physical ReportN222Incomplete Admitting History ReportN223Missing Documentation ExplainedN224Incomplete Documentation of BenefitsN226Incomplete ADA CertificateN227Incomplete Medical Necessity CertificateN228Incomplete/Invalid Consent FormN229Incomplete/Invalid Contract IndicatorN230N230 Remark Code | Patient Equipment Ownership IssueN231Incomplete Lens Invoice ExplanationN232Incomplete/Invalid Itemized BillN233Incomplete Operative NoteN234Oxygen Certification IssuesN235Incomplete Pacemaker Registration FormN236Incomplete/Invalid Pathology ReportN237Incomplete Patient Medical RecordN238Incomplete Physician Plan of CareN239Incomplete/Invalid Physician FormN240Incomplete/Invalid Radiology ReportN241Incomplete Review Org Approval ExplainedN242Incomplete/Invalid Radiology ImagesN243Incomplete Screening DocumentN244Incomplete/Invalid Pre-Operative ImagesN245Incomplete/Invalid Plan InformationN246Patient Payment Limitations ExplainedN247Assistant Surgeon Taxonomy IssueN248Missing Assistant Surgeon NameN249Missing Assistant Surgeon IdentifierN250Missing Assistant Surgeon IdentifierN251Attending Provider Taxonomy IssueN252Missing Attending Provider NameN253Missing Provider Identifier ExplainedN254Missing Attending Provider IdentifierN255Missing/Invalid Billing Provider TaxonomyN256Missing/Invalid Billing Provider NameN257Missing Billing Provider IdentifierN258Invalid Billing Provider AddressN259Missing/Incomplete Provider IdentifierN260Missing Billing Provider Contact InfoN261Missing Operating Provider NameN262Missing Provider Identifier IssueN263Missing Provider Identifier ExplainedN264Missing Ordering Provider Name ExplanationN265Missing Ordering Provider IdentifierN266Missing Provider Address ExplainedN267Missing Ordering Provider IdentifierN268Missing Ordering Provider InfoN269Missing/Incomplete/Invalid Provider NameN270Missing Provider Identifier ExplainedN271Missing Provider Identifier ExplainedN272Missing Provider Identifier ExplanationN273Missing Provider Identifier ExplainedN274Missing Other Payer IdentifierN275Missing Provider Identifier ExplainedN276Missing Referring Provider IdentifierN277Missing Provider IdentifierN278Missing Facility Provider IdentifierN279Missing Pay-to Provider NameN280Missing Provider Identifier ExplainedN281Provider Address Issue ExplainedN282Missing Pay-To Provider IdentifierN283Missing Provider Identifier ExplanationN284Referring Provider Taxonomy IssueN285Missing Referring Provider NameN286Referring Provider Identifier IssueN287Missing Referring Provider IdentifierN288Provider Taxonomy Issue ExplainedN289Missing Rendering Provider NameN290Missing Provider Identifier ExplainedN291Rendering Provider Identifier IssuesN292Missing Service Facility NameN293Service Facility Identifier IssueN294Missing Facility Address ExplainedN295Missing Service Facility IdentifierN296Missing Supervising Provider NameN297Missing Supervising Provider IdentifierN298Supervising Provider Identifier IssuesN299Missing or Invalid Occurrence DatesN300Missing or Invalid Occurrence DatesN301Missing Procedure Dates ExplainedN302Missing/Invalid Procedure DatesN303Missing Principal Procedure DateN304Missing Dispensed Date ExplanationN305Missing Injury/Accident Date ExplainedN306Missing Acute Manifestation DateN307Missing Payment Date ExplanationN308Missing Appliance Placement DateN309Missing Assessment DateN310Missing Care Date ExplainedN311Missing Return to Work Date ExplainedN312Missing Therapy Begin DateN313Missing Certification Revision DateN314Diagnosis Date Issues ExplainedN315Missing/Incomplete Disability DateN316Missing Disability To Date ExplanationN317Missing Discharge Hour ExplainedN318Missing Discharge or End of Care DateN319Missing Vision/Hearing Prescription DateN320Home Health Certification IssuesN321Missing Last Admission Period ExplainedN322Missing Certification Date ExplainedN323Missing Last Contact Date ExplainedN324Missing/Invalid Last Seen DateN325Missing Last Worked Date ExplainedN326Missing X-Ray Date ExplanationN327Missing Other Insured Birth DateN328Oxygen Saturation Test Date IssueN329Missing Patient Birth DateN330Missing Patient Death Date ExplanationN331Physician Order Date IssuesN332Missing Prior Hospital Discharge DateN333Missing Prior Placement Date ExplainedN334Missing Re-evaluation Date ExplainedN335Missing/Invalid Referral DateN336Missing Replacement Date ExplanationN337Missing Secondary Diagnosis DateN338Missing Shipped Date ExplainedN339Missing Similar Illness Date ExplainedN340Subscriber Birth Date IssueN341Missing Surgery Date ExplanationN342Missing Test Performed Date MeaningN343TENS Trial Start Date IssueN344TENS Trial End Date IssuesN345Date Range Not ValidN346Missing Oral Cavity DesignationN347Duplicate Service Payment ExplainedN348Service Billed by Different ProviderN349Administration Method RequiredN350Service Description IssuesN351Service Date Outside Approved Treatment PlanN352 ℹNo Scheduled Payments AlertN353 ℹEstimated Benefits AlertN354Incomplete/Invalid Invoice ExplanationN355 ℹRefund Requirement AlertN356Not Covered with Non-Covered ServiceN357Time Frame Requirements Not MetN358 ℹReview Decision with Additional DocumentationN359Missing Height Information ExplainedN360 ℹCoordination of Benefits AlertN362Days or Units Exceed MaximumN363 ℹUpcoming Policy Changes AlertN364 ℹWaive Deductible/Coin Insurance AlertN366Requested Information Not ProvidedN367 ℹClaim Forwarded to Processor AlertN368Appeal Required for ClaimN369 ℹClaim Deficiency AlertN370Billing Exceeds Rental CoverageN371 ℹEquipment Title Transfer AlertN372Maintenance Charges CoverageN373Incorrect Primary Payer AdjustmentN374Medicare Part A ExhaustedN375Dependent Eligibility Information RequiredN376Military Duty Impacts CoverageN377Payment Based on Replacement ClaimN378Prescription Quantity IssuesN379Claim Level vs Line Level DiscrepancyN380Submit a Corrected ClaimN381 ℹContractual Agreement AlertN382Missing Patient Identifier ExplainedN383Not Covered When Deemed CosmeticN384Body Part/Tooth RemovedN385Admission Notification TimelinessN386National Coverage Determination InfoN387 ℹInformational Alert for Supplemental ClaimsN388Missing Prescription NumberN389Duplicate Prescription NumberN390This Service Cannot Be Billed SeparatelyN391Missing Emergency Department RecordsN392Incomplete Emergency Department RecordsN393Missing Progress Notes ExplanationN394Incomplete/Invalid Progress NotesN395Missing Laboratory Report ExplanationN396Incomplete/Invalid Laboratory ReportN397Benefits Not Available for Incomplete ServicesN398Missing Elective Consent FormN399Incomplete Consent Form ExplanationN400 ℹSubmission Alert for ProvidersN401Missing Periodontal ChartingN402Incomplete Periodontal ChartingN403Missing Facility CertificationN404Incomplete/Invalid Facility CertificationN405Service Coverage ConditionsN406Coverage Conditional on Other InsurersN407Not Approved Submitter for FormatN408No Coverage for Previous DeductiblesN409Accidental Injury Coverage LimitsN410Not Covered Unless Prescription ChangesN411One Time Service LimitN412Service Frequency Limit ExplanationN413Frequency Limit Exceeded ExplanationN414Service Frequency Limit ExplainedN415Service Limited to 1 Time in 18 MonthsN416Service Allowed 1 Time in 3 YearsN417Service Limited to 1 Time in 5 YearsN418Misrouted Claim ExplanationN419Retroactive Adjustment ExplanationN420Retroactive Adjustment ExplainedN421Retroactive Adjustment ExplanationN422Retroactive Payment AdjustmentN423Retroactive Adjustment ExplanationN424Geographic Area Payment IssueN425Statutorily Excluded Service ExplanationN426No Coverage When Self-AdministeredN427Payment for Eyeglasses or Contact LensesN428Not Covered by Place of ServiceN429Not Covered When Considered RoutineN430Procedure Code InconsistencyN431Not Covered with This ProcedureN432 ℹRecovery Audit Adjustment AlertN433Resubmit Claim with NPIN434Missing POA Indicator ExplainedN435Exceeds Allowed FrequencyN436Injury Claim Not AcceptedN437 ℹInjury Claim NotificationN438Jurisdiction Only Accepts Paper ClaimsN439Missing Anesthesia Report ExplainedN440Incomplete Anesthesia ReportN441Missed Appointment Not CoveredN442Payment Based on Alternate Fee ScheduleN443Time Reporting IssuesN444 ℹInformational Alert on ComplianceN445Missing Document for Cost ValidationN446Incomplete/Invalid Document ExplanationN447Payment Based on Generic EquivalentN448Not Included in Fee ScheduleN449Payment Based on Comparable ItemN450Provider Coverage RestrictionsN451Missing Admission Summary ReportN452Incomplete Admission Summary ReportN453Missing Consultation ReportN454Incomplete/Invalid Consultation ReportN455Missing Physician Order ExplanationN456Incomplete/Invalid Physician OrderN457Missing Diagnostic Report ExplainedN458Incomplete/Invalid Diagnostic ReportN459Missing Discharge Summary ExplainedN460Incomplete/Invalid Discharge SummaryN461Missing Nursing Notes ExplanationN462Incomplete/Invalid Nursing NotesN463Missing Support Data ExplainedN464Incomplete/Invalid Support DataN465Missing Physical Therapy NotesN466Incomplete Physical Therapy NotesN467Missing Tests and Analysis ReportN468Incomplete/Invalid Test ReportN469 ℹAppeal Process AlertN470Mandatory Medical Reimbursement LimitN471Missing HIPPS Rate Code ExplainedN472Payment Issued to Another ProviderN473Missing Certification ExplainedN474Incomplete/Invalid CertificationN475Missing Completed Referral FormN476Incomplete Referral Form ExplainedN477Missing Dental Models ExplainedN478Incomplete/Invalid Dental ModelsN479Missing Explanation of BenefitsN480Incomplete/Invalid EOB ExplainedN481Missing Models ExplanationN482Incomplete/Invalid Models ExplainedN485Missing Physical Therapy CertificationN486Incomplete/Invalid PT CertificationN487Missing Prosthetics/Orthotics CertificationN488Incomplete/invalid CertificationN489Missing Referral Form ExplanationN490Incomplete/Invalid Referral FormN491Missing Exclusionary Rider ConditionN492 ℹNetwork Provider Billing AlertN493Missing Doctor First Report of InjuryN494Incomplete/Invalid Doctor ReportN495Missing Supplemental Medical ReportN496Incomplete/Invalid Supplemental ReportN497Missing Medical Report ExplanationN498Incomplete/Invalid Disability ReportN499Missing Medical Legal ReportN500Incomplete Medical Legal ReportN501Missing Vocational Report ExplainedN502Incomplete Vocational Report ExplanationN503Missing Work Status ReportN504Incomplete/Invalid Work Status ReportN505 ℹAlert on Real-Time EstimatesN506 ℹMember Liability Estimate AlertN507Distance Requirements Not MetN508 ℹMember Responsibility AlertN509 ℹConsumer Spending Account AlertN510 ℹConsumer Spending Account AlertN511 ℹConsumer Spending Account Info AlertN512 ℹInitial Remit NotificationN513 ℹInitial Remit Alert for ClaimsN516NPI and EIN Mismatch ExplanationN517Resubmit Claim with InformationN518No Separate Payment for AccessoriesN519Invalid Combination of ModifiersN520 ℹConsumer Spending Account Payment AlertN521Provider Information MismatchN522Duplicate Claim ProcessedN523Outlier Payment Limitation ExplainedN524Payment in Full ExplanationN525Services Not Covered in Global PeriodN526Not Qualified for RecoveryN527Primary Payer Processing InformationN528Institutional Services OnlyN529Professional Services Only EntitlementN530Not Qualified for RecoveryN531Not Qualified for RecoveryN532Not Qualified for Recovery ExplanationN533Services in Indian Health Services FacilityN534Individual Policy ExplanationN535Payment Adjusted by Place of ServiceN536Patient Responsibility Not ChangedN537No Records Found for ServicesN538Facility Payment ResponsibilityN539 ℹAppeal Denied AlertN540Payment Adjusted for Interrupted StayN541Insurance Type Mismatch ExplanationN542Missing Income VerificationN543Incomplete/Invalid Income VerificationN544 ℹProvider Mismatch AlertN545Payment Reduction for ePrescribingN546eRx Incentive Program Payment AdjustmentN547Refund Request ProcessedN548 ℹPatient Deductible Met AlertN549 ℹPatient Out-of-Pocket Maximum MetN550 ℹEnrollment Revalidation AlertN551ASC Quality Reporting AdjustmentN552Payment Adjusted for Withhold ReversalN554Family Planning Indicator IssuesN555Missing Medication List ExplainedN556Incomplete/Invalid Medication ListN557Service Area Not PayableN558Service Area Non-Payable ExplanationN559Service Area Not PayableN560Claim Not Received Within 60 DaysN561Bundled Claim and Readmissions GuidanceN562Provider Number Mismatch ExplainedN563 ℹPatient Notice of Non-Coverage AlertN564Patient Inclusion Criteria Not MetN565 ℹModifier Required for ClaimsN566 ℹFunctional Reporting AlertN567Not Covered When Considered PreventativeN568 ℹInitial Payment Alert for Bundled PaymentsN569Not Covered for Reported DiagnosisN570Missing Credentialing Data ExplainedN571 ℹPayment Issued QuarterlyN572Non-Payable Reporting Codes RequiredN573 ℹOverpayment Alert NotificationN574Provider Specialty IssueN575Provider Name Mismatch ExplainedN576Services Not Related to ClaimN577Personal Injury Protection CoverageN578Coverages Do Not ApplyN579Medical Payments Coverage ExplanationN580Determination Based on Policy ProvisionsN581Investigation of Coverage Eligibility PendingN582Benefits Suspended Pending CooperationN583Patient Not Occupant of Insured VehicleN584Noncompliance with Policy ConditionsN585Benefits No Longer AvailableN586Injured Party Does Not QualifyN587Policy Benefits ExhaustedN588Patient Payment InstructionsN589Coverage Excluded for IntoxicationN590Missing Independent Medical ExamN591Payment Based on IME or URN592Prescription Adjustment ExplainedN593IME Attendance Denial ExplainedN594Missing Application for BenefitsN595Assignment of Benefits MissingN596Medical Authorization MissingN597Adjustment Based on Apportionment of CareN598Health Care Policy Coverage is PrimaryN599Payment Based on Reasonable AmountsN600Fee Schedule Adjustment ExplainedN601Payment Based on Hawaii RBRVSN602Adjusted Based on Redbook AllowanceN603NJ Fee Schedule ExplanationN604New York No-Fault Fee AdjustmentN605APR-DRG Fee Calculation ExplainedN606Oregon Workers Compensation Fee ScheduleN607Service for Non-Compensable ConditionsN608Fee Schedule Calculation ExplainedN609Payment Recommendation ExplanationN610 ℹPayment Based on Appropriate Level of CareN611Claim in Litigation ExplainedN612Provider Not Authorized for TreatmentN613 ℹProvider Enrollment AlertN614 ℹAlert for Additional InfoN615 ℹGrace Period InformationN616 ℹAdvance Premium Tax Credit AlertN617Grace Period for Premium Tax CreditN618 ℹClaim Reprocessing AlertN619Coverage Terminated for Non-PaymentN620 ℹQuality Reporting AlertN621Charges Not Payable for Required FormsN622Not Covered Based on Date of InjuryN623Not Covered Due to Unproven StatusN624Workers' Comp Claim WithdrawnN625Missing Workers' Comp Claim NumberN626E/M Codes Not Payable with Chiropractic CareN628Out-Patient Follow-Up VisitsN629Documentation Not RequestedN630Referral Not AuthorizedN631Medical Fee Schedule ExplanationN633Additional Anesthesia Time Units Not AllowedN634Anesthesia Time Units ExplainedN635Anesthesia Allowance CalculationN636Adjusted for Reimbursement LimitN637Consultation Denial ExplainedN638Home Health Fee Schedule ReimbursementN639Inpatient Rehabilitation Fee ScheduleN640Service Frequency ExceededN641Reimbursement Based on Body AreasN642Adjusted for Individual TestsN643Not Covered Services ExplanationN644Bilateral Procedure Rule ExplanationN645Mark-up Allowance ExplainedN646Assistant Reimbursement AdjustmentN647Adjusted Based on DRGN648Adjusted Based on Stop LossN649Payment Based on InvoiceN650Policy Not in Effect for Service DateN651No PIP/Medical Payments CoverageN652Date of Service Before Date of LossN653Date of Injury DiscrepancyN654Maximum Medical Improvement AdjustmentN655Payment Based on Geographic RegionN656Interest Payment ExplainedN657Appropriate Code RequiredN658Non-Medical Expense ExplanationN659Exempt from Sales TaxN660Sales Tax Included in ReimbursementN661Documentation Not Supporting Medical NecessityN662 ℹPayment Consideration on Final BillN663Adjusted Based on Agreed AmountN664Adjusted Based on Legal SettlementN665Unlicensed Provider Services Not ReimbursableN666E/M Coverage Limitation ExplainedN667Missing Prescription ExplainedN668Incomplete/Invalid Prescription ExplanationN669Adjusted Based on Medicare Fee ScheduleN670Medicare MPPR ExplanationN671Payment Based on Cost-Charge RatioN672 ℹHealth Insurance Offset AlertN673Outpatient Reimbursement ExplainedN674Not Covered Without Prerequisite ServiceN675Additional Information RequiredN676Outpatient Facility Fee Schedule DenialN677 ℹFilms/Images Will Not Be ReturnedN678Missing Post-Operative ImagesN679Incomplete/Invalid Post-Operative ImagesN680Missing Date of Previous Dental ExtractionsN681Missing/Incomplete Full Arch SeriesN682Missing Periodontal Therapy HistoryN683Missing Treatment Documentation ExplanationN684Specialty Claim Denial ExplainedN685Missing Prosthesis, Crown or Inlay CodeN686Missing Questionnaire ExplanationN687 ℹAlert on Retroactive DisenrollmentN688 ℹMedical Review Reversal AlertN689 ℹAlert for Rate Change ReversalN690 ℹAppeal Reversal NotificationN691 ℹPatient Appeal Reversal AlertN692 ℹIncorrect Rate AlertN693 ℹClaim Cancellation AlertN694 ℹClaim Reversal AlertN695 ℹPatient Financial Responsibility AlertN696 ℹCOB or TPL Recovery AlertN697 ℹAlert on Retroactive Contract AdjustmentN698 ℹCoverage Loss Due to Premium Non-PaymentN699PQRS Payment Adjustment ExplainedN700EHR Incentive Program AdjustmentN701Value-based Payment AdjustmentN702Review of Previous ClaimsN703Service Incompatibility ExplainedN704 ℹResubmit Claim with CorrectionsN705Incomplete/Invalid DocumentationN706Missing Documentation ExplainedN707Incomplete/Invalid OrdersN708Missing Orders ExplainedN709Incomplete/Invalid Notes ExplanationN710Missing Notes ExplanationN711Incomplete/Invalid SummaryN712Missing Summary ExplanationN713Incomplete/Invalid Report ExplanationN714Missing Report ExplanationN715Incomplete/Invalid Chart ExplanationN716Missing Chart ExplanationN717Incomplete Face-to-Face DocumentationN718Missing Face-to-Face Examination DocumentationN719Penalty Based on Plan RequirementsN720 ℹPatient Overpayment AlertN721Clinical Trial Coverage ExplanationN722WCSA Funds Required for PaymentN723Liability Set-Aside Funds RequiredN724NFSA Funds Required for PaymentN725Ongoing Liability Insurer ResponsibilityN726Conditional Payment Not AllowedN727Ongoing Responsibility by No-Fault InsurerN728Workers' Compensation ResponsibilityN729Missing Patient Medical/Dental RecordN730Incomplete Patient Records ExplainedN731Incomplete Mental Health AssessmentN732Services at Unlicensed FacilityN733Regulatory Surcharges ExplainedN734Eligibility for Medical ServicesN736Incomplete/Invalid Sleep Study ReportN737Missing Sleep Study ReportN738Incomplete/Invalid Vein Study ReportN739Missing Vein Study Report ExplanationN740Insufficient Funds in Consumer Spending AccountN741Site Neutral Payment ExplainedN743Employment Accident AdjustmentN744Auto/Other Accident AdjustmentN745Missing Ambulance Report ExplainedN746Incomplete/Invalid Ambulance ReportN747Misdirected Claim/Service InstructionsN748Missing Hospital Charges AdjustmentN749Missing Blood Gas Report ExplainedN750Incomplete/Invalid Blood Gas ReportN751Medicare Part D Adjustment ExplainedN752Missing HIPPS Treatment Authorization CodeN753Missing Attachment Control NumberN754Missing Referring Provider InfoN755Missing/Invalid ICD IndicatorN756Point of Drop-Off Address IssueN757Federal Indian Fees AdjustmentN758Adjusted Based on Prior AuthorizationN759Payment Adjusted per NEMA StandardN760Facility Not Authorized for PaymentN761Provider Not Authorized for PaymentN762Facility Not Certified for TomosynthesisN763Demonstration Code IssueN764Missing Hematocrit Value ExplanationN765Coinsurance Not CoveredN766Co-Payment Not CoveredN767Medicaid Enrollment RequiredN768Incomplete/Invalid Evaluation ReportN769Lateral Diagnosis RequiredN770Adjustment Request ProcessedN771 ℹFederal Limiting Charge AlertN772 ℹSeparate Billing AlertN773Drug Not From Specialty VendorN774 ℹAlert on Payment FeesN775Payment Adjusted for X-Ray FilmN776Not a Covered Telehealth ServiceN777Missing Assignment of Benefits IndicatorN778Missing Primary Care Physician InfoN779Replacement Claims FinalizationN780Missing End Therapy Date ExplainedN781 ℹMedicaid Alert for Deductible ReviewN782 ℹMedicaid Alert on CoinsuranceN783 ℹPatient is a Medicaid/Qualified Medicare BeneficiaryN784Missing Comprehensive Procedure CodeN785Missing Radiology Films ExplanationN786Orthodontic Benefit LimitationN787 ℹPHP Service Hour Requirement AlertN788 ℹMissing Information AlertN789Clinical Trial Not CoveredN790Provider Not AccreditedN791Missing History & Physical ReportN792Incomplete/Invalid History & Physical ReportN794Payment Adjusted by Technology TypeN795Resubmit as PurchaseN796Missing Hemoglobin Value ExplanationN797Missing/Invalid Date QualifierN798Claim Voiding InstructionsN799Individual Identifier RequiredN800Only One Service Date AllowedN801Medicare Facility Services ExplanationN802Service Area Denial ExplainedN803Claim Submission ResponsibilityN804 ℹOutpatient Code Editor AlertN805 ℹClaim Processed Through CCE AlertN806Global Transplant Allowance PaymentN807MIPS Payment AdjustmentN808Not Covered for Provider TypeN809 ℹFee Schedule Adjusted for BiddingN810 ℹDisaster Declaration Benefit AdjustmentN811Missing Federal Sequestration ReductionN812Service Date Span Exceeds 18 MonthsN815Missing/Incomplete NDC Unit CountN816Missing NDC Unit of Measure ExplainedN817 ℹInformational Alert for LaboratoriesN818Claims Dates of Service MismatchN819Patient Not Enrolled in EVV SystemN820EVV Units Do Not Meet RequirementsN821EVV Visit Not Found ExplanationN822Missing Procedure Modifier(s) ExplainedN823Incomplete/Invalid Procedure ModifiersN824EVV Data Submission RequirementN825Early Intervention Guidelines Not MetN826Medicare Shared Savings Program EligibilityN827Missing FIPS Code ExplainedN828 ℹPayment Suppressed by Contracted FundingN829Missing/Invalid Z-Code IdentifierN830 ℹNo Surprise Billing AlertN831Enrollment Revalidation RequiredN832Duplicate Occurrence Code ExplanationN833Patient Share Waived ExplainedN834Jurisdiction Tax Exemption MeaningN835Unrelated Service Reduction ExplainedN836Provider W9 Not on FileN837 ℹMissing Modifier Added AlertN838 ℹService Postponed AlertN839Service Level Exceeds Compensable ConditionsN840Worker's Compensation Claim IssuesN841 ℹNorth Dakota Rule AlertN842 ℹPatient Cannot Be BilledN843Missing CBSA Code ExplainedN844Nebraska Out of Network Emergency CareN845 ℹOut of Network Emergency Care ActN846National Drug Code MismatchN847Obsolete National Drug CodeN848NDC Not Associated with ProductN849Missing Tooth Clause ExplainedN850Missing Narrative ExplanationN851Payment Reduced for Therapy AssistantN852Provider TIN Mismatch ExplanationN853Modalities Exceeded MaximumN854 ℹAppeal Requirements for OHI ClaimsN855ERISA Coverage JurisdictionN856Coverage Not Under ERISAN857Refund Collected CopaymentN858 ℹOut of Network Emergency Care AlertN859 ℹNo Surprise Billing Act AlertN860 ℹQPA Used for Member Cost ShareN861 ℹPatient Liability Mismatch AlertN862 ℹMember Cost Share Compliance AlertN863 ℹNo Surprises Act AlertN864 ℹAlert on No Surprises ActN865 ℹNo Surprises Act AlertN866 ℹNo Surprises Act AlertN867 ℹCost Sharing Alert InformationN868 ℹCost Sharing Calculation AlertN869 ℹCost Sharing Alert Under No Surprises ActN870 ℹNo Surprises Act Cost Sharing AlertN871 ℹPayment Based on No Surprises ActN872 ℹNo Surprises Act Payment AlertN873 ℹPayment Based on No Surprises ActN874 ℹPayment through Negotiation AlertN875 ℹOut-of-Network Rate Payment AlertN876 ℹCoverage Alert Under No Surprises ActN877 ℹNo Surprises Act Payment AlertN878 ℹBalance Billing Compliance AlertN879 ℹBalance Billing AlertN880Claim Closed Due to Data ChangesN881Client Obligation for HCBSN882 ℹOut-of-Network Payment AlertN883 ℹProcessed According to State LawN884 ℹNo Surprises Act AlertN885 ℹNo Surprises Act AlertN886 ℹClaim Information Request AlertN887Appeal Rights for Medicare AdvantageN888 ℹAlert for Additional InformationN889 ℹReal-Time 835 Response AlertN890EVV Data Element Requirements Not MetN891Maximum Payment by Primary InsuranceN892Delay Reason Code Criteria IssueN893Child Medical Evaluation Form IssuesN894 ℹPayment Reservation of Rights AlertN895Specialty Drug Program Fee ScheduleN896Missing Trauma Activation SheetN897Missing Proof of Member PaymentN898Missing or Invalid RUG CodesN899Missing Initial Evaluation ReportN900Missing Therapy Notes/ReportN901Incomplete Therapy NotesN902Missing Health Risk AssessmentN903Incomplete/Invalid Health Risk AssessmentN904Transportation Vendor ResponsibilityN905Medicare Opt-Out Denial ExplanationN906Service Not Covered Under Age 45N907No Refund for 340B-Eligible ClaimsN908No Refund for Maximum Fair PriceN909Refund Calculation MethodologyN910No Refund Available for ClaimN911Manufacturer Reimbursement DelayN912Beneficiary Did Not Elect HospiceN913EVV Record Conflict ExplainedN914California AB-72 Pricing ExplainedN915Predetermination Not AllowedN916Third Party Payment ResponsibilityN917Alternative Refund Amount ExplanationN918No Refund for Compounded DrugsN919Out-of-Pocket Maximum MetN920Payment Hold Due to Contract NegotiationN921Time Limit for Reconsideration ExpiredN922Missing Primary Care Dentist InfoN923Payment Responsibility DeterminationN924Pending Payment DeterminationN925Medicare Advantage Payment DenialN926Partially Denied ExplanationN927Missing/Incomplete/Invalid X-rayN928Missing/Incomplete X-ray DocumentationN929Missing/Incomplete/Invalid PhotosN930Missing Quadrant Identifier IssueN931Missing X-ray InformationN932Missing/Invalid Full Mouth X-rayN933Missing Photo DocumentationN934Missing Full Mouth X-RayN935 ℹPatient No Longer Medicaid EligibleN936Medicare MPPR ExplanationN937Service Line Denial Threshold ExceededN938 ℹClaim Auto-Reprocessing AlertN939 ℹPeer-to-Peer Review AlertN940Missing/Incomplete X-Ray Explanation
Deactivated remark codes (79)
M33Deactivated 08/01/2004M34Deactivated 08/01/2004M35Deactivated 02/05/2005M43Deactivated 01/31/2004M48Deactivated 01/31/2004M57Deactivated 06/02/2005M58Deactivated 02/05/2005M63Deactivated 01/31/2004M68Deactivated 06/02/2005M72Deactivated 10/16/2003M78Deactivated 05/18/2006M88Deactivated 08/01/2004M92Deactivated 08/01/2004M98Deactivated 01/31/2004M101Deactivated 01/31/2004M106Deactivated 01/31/2004M108Deactivated 06/02/2005M110Deactivated 06/02/2005M118Deactivated 01/01/2011M120Deactivated 06/02/2005M128Deactivated 06/02/2005M140Deactivated 01/30/2004MA03Deactivated 10/01/2006MA05Deactivated 10/16/2003MA06Deactivated 08/01/2004MA11Deactivated 01/31/2004MA29Deactivated 06/02/2005MA38Deactivated 06/02/2005MA49Deactivated 08/01/2004MA51Deactivated 02/05/2005MA52Deactivated 06/02/2005MA78Deactivated 01/31/2004MA82Deactivated 06/02/2005MA85Deactivated 08/01/2004MA86Deactivated 08/01/2004MA87Deactivated 08/01/2004MA95Deactivated 01/01/2004MA98Deactivated 10/16/2003MA101Deactivated 01/01/2011MA102Deactivated 08/01/2004MA104Deactivated 01/31/2004MA105Deactivated 06/02/2005MA119Deactivated 05/01/2008MA124Deactivated 01/31/2004MA127Deactivated 06/02/2005MA129Deactivated 01/31/2004N14Deactivated 10/01/2007N17Deactivated 08/01/2004N18Deactivated 01/31/2004N29Deactivated 03/01/2016N38Deactivated 02/05/2005N41Deactivated 10/16/2003N44Deactivated 10/16/2003N60Deactivated 01/31/2004N66Deactivated 02/05/2005N73Deactivated 01/31/2004N100Deactivated 11/01/2016N101Deactivated 01/31/2004N102Deactivated 07/01/2016N145Deactivated 06/02/2005N164Deactivated 01/31/2004N165Deactivated 01/31/2004N166Deactivated 01/31/2004N168Deactivated 01/31/2004N169Deactivated 01/31/2004N201Deactivated 01/01/2011N225Deactivated 03/01/2016N361Deactivated 10/01/2007N365Deactivated 07/01/2014N483Deactivated 05/01/2015N484Deactivated 05/01/2015N514Deactivated 01/01/2011N515Deactivated 10/01/2009N553Deactivated 11/01/2012N627Deactivated 07/01/2014N632Deactivated 07/01/2014N735Deactivated 01/01/2016N742Deactivated 11/01/2016N793Deactivated 07/01/2020