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Back  RFI # 794: CODE INTERPRETATION

Formal vs. Informal Help Informal Formal

Submitter

Patrice Kuppe

Description

We have to send a charge to the payer once a month for Medical Home
services. This charge will then be denied on the 835. We are thinking it
would be CO/96. I am not sure what remark code makes the most sense. Is
there one that makes sense or do I need to request one?

Submitter Assigned Keywords

835 Medical Home

Response

The workgroup recommends using CARC 96, "Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)" with RARC N365, "This procedure code is not payable. It is for reporting/information purposes only."
Submission 6/3/2009
Status Date 9/14/2009
Status F - Final
Primary References
Document 835
Sectionunknown
Pageunk
Set ID835
External Code ListCARC and RARC