Remittance Advice Details (RAD)
Electronic Correlation Table to remit elect corr500
National Codes: 500 – 599 1
RAD to CARC to RARC Correlation Table
RAD Code / RAD Code Description / HIPAA CARC / CARC Description / HIPAA CAGC / CAGC Description / HIPAA RARC / RARC Description500 / Fiscal Intermediary initiated – retroactive rate correction. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
501 / Adjustment due to State Controller's Audit. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / N432 / Adjustment based on a recovery audit.
502 / Fiscal Intermediary initiated – adjustment as a result of a prior overpayment. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
503 / Fiscal Intermediary initiated – adjustment as a result of a prior underpayment. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
504 / Fiscal Intermediary initiated – adjustment due to a change in the claim date of service. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
505 / Fiscal Intermediary initiated – adjustment as a result of a change in the drug/service code. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / M67 / Missing/incomplete/
invalid other procedure code(s).
1 – RAD to National Code Correlation: 500 – 599
September 2015
Remittance Advice Details (RAD)
Electronic Correlation Table to remit elect corr500
National Codes: 500 – 599 3
RAD Code / RAD Code Description / HIPAA CARC / CARC Description / HIPAA CAGC / CAGC Description / HIPAA RARC / RARC Description506 / Fiscal Intermediary initiated – adjustment as a result of 80 percent cutback overpayment. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
507 / Fiscal Intermediary initiated void – claim paid under non-contract provider number. Please submit a new claim with contract provider number. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / N293 / Missing/incomplete/
invalid service facility primary identifier.
N380 / The original claim has been processed; submit a corrected claim.
N517 / Resubmit a new claim with the requested information.
508 / Fiscal Intermediary initiated – adjustment for payment made for wrong recipient and the right recipient is not eligible. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / N30 / Ineligible for this service.
MA36 / Missing/incomplete/
invalid patient name.
509 / Adjustment due to an inappropriate payment made for a service rendered on a denied acute (inpatient) day. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
1 – RAD to National Code Correlation: 500 – 599
August 2012
remit elect corr
3
RAD Code / RAD Code Description / HIPAA CARC / CARC Description / HIPAA CAGC / CAGC Description / HIPAA RARC / RARC Description510 / Fiscal Intermediary initiated – adjustment as a result of a change in the quantity/number of occurrences per drug/service code. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / M53 / Missing/incomplete/
invalid days or units of service.
MA67 / Correction to a prior claim.
511 / Fiscal Intermediary initiated – adjustment as a result of a change in the number of estimated days supplied/number of days authorized. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / M53 / Missing/incomplete/
invalid days or units of service.
MA67 / Correction to a prior claim.
512 / Fiscal Intermediary initiated – adjustment as a result of a change in the recipient’s other coverage. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
513 / Fiscal Intermediary initiated – adjustment as a result of a change in the provider’s eligibility status. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / N257 / Missing/incomplete/
invalid billing provider/
supplier primary identifier.
514 / Fiscal Intermediary initiated – adjustment as a result of a change in the recipient’s eligibility status. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
1 – RAD to National Code Correlation
September 2015
remit elect corr500
5
RAD Code / RAD Code Description / HIPAA CARC / CARC Description / HIPAA CAGC / CAGC Description / HIPAA RARC / RARC Description515 / Fiscal Intermediary initiated – adjustment as a result of a change in the attending, referring, or prescribing provider number. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / N253 / Missing/incomplete/
invalid attending provider primary identifier.
N433 / Resubmit this claim using only your National Provider Identifier (NPI).
516 / Fiscal Intermediary initiated – adjustment as a result of a change in the accommodation code. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / M50 / Missing/incomplete/
invalid principal procedure code.
517 / Fiscal Intermediary initiated – adjustment as a result of a change in the patient’s status code when it was not previously appropriate for the accommodation code. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA43 / Missing/incomplete/
invalid patient status.
518 / Fiscal Intermediary initiated – adjustment as a result of a change in the diagnosis code. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA63 / Missing/incomplete/
invalid principal diagnosis.
519 / Fiscal Intermediary initiated – adjustment as a result of a change in the level of care code. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
1 – RAD to National Code Correlation: 500 – 599
August 2012
remit elect corr500
5
RAD Code / RAD Code Description / HIPAA CARC / CARC Description / HIPAA CAGC / CAGC Description / HIPAA RARC / RARC Description520 / Fiscal Intermediary initiated – adjustment as a result of a claim that was erroneously denied. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
521 / Fiscal Intermediary initiated – adjustment as a result of a change in the original claims decision due to the receipt of additional information. / 96 / Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA67 / Correction to a prior claim.
N377 / Payment based on a processed replacement claim.
522 / Payment void – wrong provider number. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / N280 / Missing/incomplete/
invalid pay-to provider primary identifier.
N433 / Resubmit this claim using only your National Provider Identifier (NPI).
523 / Payment void – wrong recipient number. / 16 / Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. / CO / Contractual Obligations / MA61 / Missing/incomplete/
invalid social security number or health insurance claim number.
1 – RAD to National Code Correlation: 500 – 599