RARC Codes Library

Alert: You may appeal this decision

This non-chargeable code can only be used with Group Code PR

Missing/incomplete/invalid name

Missing/incomplete/invalid primary identifier

Missing/incomplete/invalid secondary identifier

Missing/incomplete/invalid prescribing provider ID

Crossover service not paid by Medicare

Adjustment represents collection against receivable

Payment based on professional/technical component modifier

Denial reversed per Medical Review

Policy/procedure not met

Payment based on professional component only

Payment based on technical component only

Service separately reimbursable only with 25/59 modifier

New Patient qualifiers not met

Payment adjusted - Distinct Procedural Service

Procedure code incidental to primary procedure

Procedure code not compatible with another procedure

Service not payable with other service

This service was adjudicated as Medicare Secondary Payer

Service billed is not compatible with diagnosis

Service billed incompatible with place of service

Missing/incomplete/invalid Electronic Data Interchange information

Missing/incomplete/invalid submitted modifier

Missing/incomplete/invalid level of service

Missing/incomplete/invalid unit of measurement

Consent form not present

Missing invoice/statement certifying actual cost

Patient enrolled in Hospice at time of service

Court ordered coverage information

Adjusted for failure to obtain second surgical opinion

Adjusted for failure to obtain prior authorization

Adjusted for incorrect/missing/invalid DRG code

Adjusted for incorrect/missing/invalid revenue code

Incomplete/invalid patient address

Alert: We adjusted this claim to correct errors

Claim spans eligible and ineligible dates

Claim spans pre and post coordination of benefits dates

Missing certification

Incomplete/invalid diagnostic information

Missing/incomplete/invalid place of service code

Missing/incomplete/invalid type of bill code

Overlapping dates of service

Payment based on 5 year average of charges

Payment based on average selling price

Payment based on wholesale acquisition cost

Payment based on actual acquisition cost

Payment based on invoice price

Payment adjusted for case/disease on management

Payment adjusted for institutional approved fee schedule

Payment adjusted for Medicare Advantage program payment

Service not separately priced by taxonomy

Procedure code billed is not correct/valid

Missing/incomplete/invalid provider address

Alert: Missing itemized bill/statement

Alert: Missing invoice

Alert: This was a split service. Refund applicable portion

Claim lacks individual provider certification

Missing physician signature

Missing operative note/report

Date of service predates patient eligibility

Missing pathology report

Missing radiology report

Missing patient medical record

Missing appropriate physician order

Missing/incomplete documentation

Missing physical therapy notes/evaluation

Missing itemized bill for rental/purchase of DME

Missing medical necessity/justification

Missing physician order for equipment

Missing signed/dated proof of delivery

Service not ordered by physician

Services not considered acute

No appeal rights - claim processed per contract

Alert: Processed per plan provisions

Alert: Claim information fowarded to other payer

Alert: Claim/service(s) subject to appeal

Alert: Records indicate patient is deceased

Alert: This is decision final for this claim

Alert: Statutory deductible applied

Missing referral documentation

Alert: Adjusted for Quality Reporting Program

Alert: Claim review in progress

Alert: Decision appeal pending

Missing/incomplete discharge information

This provider type/provider specialist may not bill service

Service type/provider type inconsistent

Alert: Claim/service corrected

Alert: Claim combined/bundled with prior claim

Missing patient height/weight

Payment adjusted bundled incorrectly

Service not furnished by home health agency

Records indicate adjusted to full charge

Service adjusted - submitted review period

Alert: Claim processed per plan/benefit design

Payment representing specific funded benefits

Related medical visit on same day not included

Missing/incomplete insurance information

Alert: You may request review within 120 days

Payment based on per diem rate

Alert: Your facility is required to submit claims electronically

Alert: Appeal procedures not followed

Transfer/discharge not in benefit period

Alert: Submit appropriate documentation

Alert: Records indicate new patient

Alert: Records indicate established patient

Alert: Submit via electronic claims submission

Add-on code without primary procedure

Missing plan adoption date

Payment adjusted - multiple surgical procedures

Payment adjusted - bilateral procedures

Consult plan benefit documents

Not eligible for bundled payment

Alert: Per regulatory requirements

Alert: Records indicate no physician supervision

Records indicate physician did not order this

Alert: To obtain information call customer service

Alert: Legal obligation covered by another entity

Alert: Correction to prior processed claim

Alert: Adjusted patient liability