REMITTANCE ADJUSTMENT REASON CODE (RARC) DISPLAYED ON THE REMITTANCE ADVICE (RA)
DESCRIPTION
CLAIM ADJUSTMENT REASON CODE (CARC) DISPLAYED ON REMITTANCE ADVICE (RA)
GENERIC DENIAL CODE
GENERIC REASON STATEMENT
N522
THIS IS A DUPLICATE CLAIM BILLED BY THE SAME PROVIDER
18
GBA01
THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY THE SAME PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3
N522
THIS IS A DUPLICATE CLAIM BILLED BY DIFFERENT PROVIDER
18
GBA02
THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY A DIFFERENT PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3
N706
NO RECORDS WERE SUBMITTED
250
GBB01
THE REQUESTED RECORDS WERE NOT RECEIVED. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8
N705
INCOMPLETE/ INSUFFICIENT DOCUMENTATION
251
GBB02
THE DOCUMENTATION SUBMITTED WAS INCOMPLETE AND/OR INSUFFICIENT. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8, B/C
N163
THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE
150
GBB03
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT SERVICES WERE RENDERED AS BILLED. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A
N455
DOES NOT CONTAIN PROVIDER ORDER
251
GBB04
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A PHYSICIAN ORDER. REFER TO IOM, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2
N382
MISSING PATIENT IDENTIFIERS
16
GBB05
THE DOCUMENTATION SUBMITTED WAS MISSING PATIENT IDENTIFIERS. REFER TO STANDARDS FOR ADEQUACY OF MEDICAL RECORDS; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT
M53
INCORRECT DATE OF SERVICE
110
GBB06
THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT DATE OF SERVICE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2
N519
INCORRECT MODIFIER
4
GBB07
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MODIFIERS BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, IOM PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1
N563
ABN DENIAL
116
GBB08
THE ABN IS INVALID, INCOMPLETE OR MISSING. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 40.3.6
MA36
THE BENEFICIARY NAME ON THE DOCUMENTATION DOES NOT MATCH WHAT IS ON THE CLAIM
16
GBB09
THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT BENEFICIARY. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8
N205
ILLEGIBLE DOCUMENTATION
50
GBB10
THE DOCUMENTATION SUBMITTED IS NOT LEGIBLE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3 SECTION 3.3.2.1
M53
THE DOCUMENTATION DOES NOT SUPPORT THE NUMBER OF UNITS BILLED
222
GBB11
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE NUMBER OF UNITS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23
N661
DOES NOT MEET MEDICAL NECESSITY
50
GBC01
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY AS LISTED IN COVERAGE REQUIREMENT. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2
N661
DOES NOT MEET MEDICAL
NECESSITY
50
GBC02
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.1, 3.6.2.2
N643
NON COVERED SERVICE
96
GBC03
THE SERVICE BILLED IS NOT A COVERED MEDICARE BENEFIT OR IS AN EXCLUDED SERVICE. REFER TO 42 CFR 411.15. MEDICARE BENEFIT POLICY MANUAL CHAPTER 16; CFR TITLE 42, CHAPTER IV, SUBCHAPTER B, PART 411
N435
DOES NOT SUPPORT NUMBER OF SERVICES FOR TIMEFRAME
151
GBC04
THE DOCUMENTATION PROVIDED DOES NOT SUPPORT THE MEDICAL NECESSITY FOR THIS NUMBER OF SERVICES OR ITEMS WITHIN THIS TIMEFRAME. REFER TO SSA 1862, IOM, 100-08, MPIM CHAPTER 3, SECTION 3.6.2.2
N362
THE MAX BENEFIT AS BEEN REACHED FOR THIS SERVICE
114
GBC05
THE MAXIMUM BENEFIT HAS BEEN REACHED FOR THIS SERVICE. REFER TO IOM, PUB 100-02, MEDICARE BENEFIT POLICY MANUAL CHAPTER 5 AND IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5 A
N429
SERVICE WAS PERFORMED FOR ROUTINE/SCREENING BUT IS NOT A COVERED MEDICARE SCREENING BENEFIT
96
GBC06
THE DOCUMENTATION INDICATES THAT THE SERVICE WAS PERFORMED FOR ROUTINE/SCREENING PURPOSES BUT IS NOT COVERED UNDER MEDICARE’S SCREENING BENEFIT. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 18
N705
BILLING ERROR
16
GBD01
BILLING ERROR. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4; 100-04 MEDICARE CLAIMS PROCESSING MANUAL, CHAPTER 23.
M15
BUNDLED OR INCLUDED IN ANOTHER CODE BILLED
97
GBD03
BUNDLED OR INCLUDED IN ANOTHER CODE BILLED (NCCI). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 20.3; NATIONAL CORRECT CODING INITIATIVE CODING POLICY MANUAL FOR MEDICARE SERVICES; MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1
N163
DOES NOT SUPPORT SERVICE BILLED
50
GBD04
THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE WAS PERFORMED AS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23
M64
DOES NOT SUPPORT DIAGNOSIS
11
GBD05
THE DOCUMENTATION DOES NOT SUPPORT THE DIAGNOSIS CODE BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1
N525
GLOBAL SURGERY PERIOD
97
GBD06
PAYMENT FOR THIS SERVICE IS COMPENSATED IN THE GLOBAL SURGICAL PERIOD. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12 SECTION 30.6.6
M15
BUNDLED IN ANOTHER SERVICE ON THE SAME DOS
97
GBD07
PAYMENT IS INCLUDED IN ANOTHER SERVICE RECEIVED ON THE SAME DATE (BUNDLED). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30 & 40
MA50
INVESTIGATIONAL
55
GBD08
THIS SERVICE OR PROCEDURE IS CONSIDERED INVESTIGATIONAL AND, THEREFORE, NOT COVERED BY MEDICARE. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2
N163
DOES NOT SUPPORT ORDERED SERVICE
50
GBD09
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE ORDERED SERVICE. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A
N519
DOES NOT SUPPORT CPT MODIFIER 25
236
GBD10
THE DOCUMENTATION DOES NOT SUPPORT THAT A SEPARATELY IDENTIFIABLE SERVICE WAS PERFORMED. REFER TO IOM MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30.6; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT
N19
APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID
96
GBD11
THE APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.4
N383
COSMETIC PURPOSES
96
GBD12
THE DOCUMENTATION SUBMITTED INDICATES THE SERVICE WAS PERFORMED FOR COSMETIC PURPOSES. REFER TO MEDICARE BENEFIT POLICY MANUAL CHAPTER 16, SECTION 120
N163
CLONED DOCUMENTATION
50
GBD13
THE DOCUMENTATION SUBMITTED CONTAINS CLONED OR ALTERED INFORMATION. REFER TO PUB 100-8, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.3.2.5; CHAPTER 4.3
N705
BILLING ERROR
250
GBD14
THE PROVIDER INDICATED SERVICES WERE BILLED IN ERROR. REFER TO SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT
N206
DOCUMENT CONTAINS CONFLICTING INFORMATION
50
GBD15
THE DOCUMENTATION CONTAINS CONFLICTING INFORMATION. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.3
M102
NOT FDA APPROVED
55
GBD16
THE SERVICE OR DEVICE WAS NOT FDA APPROVED. REFER TO SSA 1862; MEDICARE BENEFIT POLICY MANUAL CHAPTER 14
N425
STATUTORILY EXCLUDED
96
GBD17
THE SERVICE BILLED IS STATUTORILY EXCLUDED. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 20.1.1, SOCIAL SECURITY ACT 1862 (A), 12 CFR 411.15, MEDICARE BENEFIT POLICY MANUAL CHAPTER 16
N55
PERFORMING PROVIDER IS NOT BILLING PROVIDER
B20/16
GBD18
THE DOCUMENTATION SUBMITTED SUPPORTS THE PERFORMING AND BILLING PROVIDERS ARE DIFFERENT
M25
DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED
150
GBE01
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MEDICAL NECESSITY OF THE LEVEL OF SERVICE BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23
M25
DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED
150
GBE02
THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.4
MA81
INVALID SIGNATURE OR CREDENTIALS
50
GBF01
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND/OR CREDENTIALS. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24
MA81
NO RESPONSE TO ATTESTATION OR SIGNATURE LOG
16
GBF02
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND A RESPONSE TO ATTESTATION OR SIGNATURE LOG REQUEST WAS NOT RECEIVED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24
MA81
STAMPED SIGNATURE
50
GBF03
STAMPED SIGNATURES ARE NOT ACCEPTED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4
N170
DID NOT INCLUDE REQUIRED CERTIFICATIONS
50
GBG01
THE DOCUMENTATION SUBMITTED DID NOT INCLUDE THE REQUIRED CERTIFICATIONS OR RECERTIFICATIONS. REFER TO MEDICARE BENEFIT POLICY MANUAL, CHAPTER 15, 220.1.3
MA81
NOT A VALID NPI
207
GBH01
THE CLAIM DID NOT INCLUDE A VALID NPI. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1, SECTION 80.3.1
N705
DID NOT CONTAIN REQUIRED INFORMATION
50
GBH02
THE CLAIM SUBMITTED DID NOT CONTAIN REQUIRED INFORMATION