How To Fix Remark Code M11 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code M11 means that DME (Durable Medical Equipment), orthotics, and prosthetics must be billed to the DME carrier who services the patient’s zip code. This code is used to indicate that the claim for these specific services should be submitted to the appropriate DME carrier based on the patient’s location.

1. Description

Remark Code M11 is used to specify that DME, orthotics, and prosthetics should be billed to the DME carrier who services the patient’s zip code. The official description states: ‘DME, orthotics and prosthetics must be billed to the DME carrier who services the patient’s zip code.’ This requirement ensures that claims for these services are directed to the correct carrier for processing and reimbursement.

2. Common Reasons

1. Incorrect billing to the wrong carrier: One common reason for Remark Code M11 is when DME, orthotics, or prosthetics are billed to the wrong carrier. This may happen due to confusion or lack of awareness regarding the specific carrier responsible for the patient’s zip code.
2. Failure to verify the patient’s zip code: Another reason for this remark code is when the provider fails to verify the patient’s zip code before submitting the claim. Accurate zip code information is crucial for determining the appropriate DME carrier.
3. Out-of-network billing: Remark Code M11 may also be triggered when DME, orthotics, or prosthetics are billed to an out-of-network carrier. It is essential to ensure that the services are billed to the carrier within the patient’s network.

3. Next Steps

1. Verify the patient’s zip code: Before submitting a claim for DME, orthotics, or prosthetics, it is important to verify the patient’s zip code. This can be done by checking the patient’s address or contacting the insurance company for accurate information.
2. Identify the appropriate DME carrier: Once the patient’s zip code is confirmed, identify the DME carrier responsible for that specific area. This information can be obtained from the insurance company or through online resources provided by the carrier.
3. Submit the claim to the correct carrier: Ensure that the claim for DME, orthotics, or prosthetics is submitted to the appropriate DME carrier based on the patient’s zip code. This will help expedite the processing and reimbursement of the claim.

4. How To Avoid It

1. Stay updated with carrier information: Keep track of the DME carriers associated with different zip codes to ensure accurate billing. Regularly review and update the list of carriers to avoid any confusion.
2. Double-check patient information: Always verify the patient’s zip code and other relevant details before submitting a claim. Accurate patient information is crucial for proper billing and reimbursement.
3. Communicate with the insurance company: If there is any uncertainty regarding the appropriate DME carrier for a specific zip code, reach out to the insurance company for clarification. They can provide guidance and ensure accurate billing.

5. Example Cases

1. Case 1: A claim for orthotics is denied because it was billed to the wrong DME carrier. By verifying the patient’s zip code and submitting the claim to the correct carrier, the denial can be avoided.
2. Case 2: A prosthetics claim is delayed in processing because it was submitted to an out-of-network DME carrier. By ensuring that the claim is directed to the appropriate in-network carrier, the processing time can be expedited.

Source: Remittance Advice Remark Codes