Health Care Remittance Advice Remark Codes

$447.50 / year

Healthcare Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing for all medical claims.

Complexity

The HIPAA or Health Insurance Portability and Accountability Act of 1996, instructs medical healthcare plans to use the standard electronic transactions adopted under this agency by using the following valid standard codes. Each Remittance Advice Remark Codes (RARC) identifies a specific message as shown in the RARC Code List.

There are two types of RARCs, supplemental and informational. The majority of the RARCs are supplemental; these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC). The second type of RARC is informational; these RARCs are often referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC.

The Centers for Medicare & Medicaid Services (CMS) maintain and annually update a List of Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) Codes (Code List), which identifies all the items and services included within certain DHS categories. CMS updates the Code List to conform the list to the most recent publications of CPT and HCPCS and to account for changes in Medicare coverage and payment policies. The updated Code List is published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. That rule is usually published in November and generally becomes effective January 1 of the following year. In addition, we may publish other rules or correction notices that may change the Code List. CMS posts any changes to the Code List on its webpage as soon as possible after publication in the Federal Register.

The DHS categories defined by the Code List are:
– Clinical laboratory services;
– Physical therapy services, occupational therapy services, outpatient speech-language pathology services;
– Radiology and certain other imaging services; and
– Radiation therapy services and supplies.

**NOTE**: The following DHS categories are defined at 42 CFR §411.351 without reference to the Code List:
– Durable medical equipment and supplies;
– Parenteral and enteral nutrients, equipment and supplies;
– Prosthetics, orthotics, and prosthetic devices and supplies;
– Home health services;
– Outpatient prescription drugs; and
– Inpatient and outpatient hospital services.

Date Created

1997-01-01

Last Modified

2020-03-20

Version

2020-03-20

Update Frequency

Irregular

Temporal Coverage

1997 to 2019

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Remittance Advice Remark Codes, Medicaid Remark Coces, Medicare Adjustment Reason Codes, Remittance Codes, Supplemental Remittance Advice Remark Codes, Informational Remittance Advice Remark Codes, Medical Billing, Explanation of Benefit (EOB) Codes, Denial Code, Medicare Denial Codes

Other Titles

Health Insurance Portability and Accountability Act (HIPAA) Standard Electronic Transactions, Medicare Appropriate Remittance Advice Remark Codes, Supplemental Remittance Advice Remark Codes, Informational Remittance Advice Remark Codes, Medicaid Remittance Processing, Medical Billing and Remittance Advice Remark Codes, EOB Codes and Remittance Advice Remark Codes, Denial Code and Remittance Advice Remark Codes

NameDescriptionTypeConstraints
CodeRemittance Advice Remark Codesstringrequired : 1 unique : 1
DescriptionDescription for each Remittance Advice Remark Codestringrequired : 1
TypeType of Remittance Advice Remark Codes whether supplemental (these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a CARC) or informational (these RARCs are often referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC).stringrequired : 1
Start_DateDate the Remittance Advice Remark Code started usagedaterequired : 1
Last_ModifiedDate the Remittance Advice Remark Code was changed/modifieddate-
Stop_DateDate the CARC was deactivated/stoppeddate-
StatusCode update whether Active, To be Deactivated or Deactivatedstringrequired : 1
NotesExplanation to redundant and/or replacement Remittance Advice Remark Codestring-
CodeDescriptionTypeStart DateLast ModifiedStop DateStatusNotes
M1X-ray not taken within the past 12 months or near enough to the start of treatment.Supplemental1997-01-01Active
M2Not paid separately when the patient is an inpatient.Supplemental1997-01-01Active
M3Equipment is the same or similar to equipment already being used.Supplemental1997-01-01Active
M4This is the last monthly installment payment for this durable medical equipment.Informational1997-01-012007-04-01Active
M5Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.Supplemental1997-01-01Active
M6You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.Informational1997-01-012009-03-01Active
M7No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.Supplemental1997-01-012016-11-01Active
M8We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.Supplemental1997-01-01Active
M9This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.Informational1997-01-012007-04-01Active
M10Equipment purchases are limited to the first or the tenth month of medical necessity.Supplemental1997-01-01Active