How To Fix Remark Code M128 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code MA12 means that you have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s). This code is used to indicate that there is an issue with the billing authorization or documentation related to the services provided.

1. Description

Remark Code MA12 indicates that you have not established the legal right to bill for the services provided by the person(s) who furnished them. This means that there is a problem with the authorization or documentation required to support the billing of these services. It is crucial to ensure that you have the necessary legal authority to bill for the services rendered to avoid claim denials or adjustments.

2. Common Reasons

1. Lack of proper authorization: One of the most common reasons for Remark Code MA12 is the absence of proper authorization to bill for the services provided. This could be due to missing or incomplete documentation, failure to obtain the required consent, or not meeting the legal requirements for billing.
2. Incorrect or invalid provider information: Another reason for this remark code is when the provider information provided on the claim is incorrect or invalid. This could include errors in the provider’s name, National Provider Identifier (NPI), or other identifying information.
3. Non-compliance with legal regulations: Remark Code MA12 may also be triggered if the services provided do not comply with the legal regulations governing the billing of healthcare services. This could include services performed by individuals who are not authorized or licensed to provide those specific services.

3. Next Steps

1. Review the authorization and documentation: The first step to address Remark Code MA12 is to thoroughly review the authorization and documentation related to the services provided. Ensure that all necessary consents and legal requirements are met.
2. Correct any errors in provider information: If the remark code is due to incorrect or invalid provider information, it is essential to correct the errors and ensure that accurate and up-to-date provider information is submitted with the claim.
3. Seek legal advice if needed: If you are unsure about the legal requirements or have questions regarding the billing authorization, it is advisable to seek legal advice to ensure compliance with the law.

4. How To Avoid It

1. Establish proper authorization processes: Implement robust authorization processes to ensure that all necessary consents and legal requirements are met before providing services.
2. Verify and update provider information: Regularly verify and update provider information to ensure accuracy and validity. This includes verifying the provider’s credentials, NPI, and other identifying information.
3. Stay informed about legal regulations: Stay updated with the latest legal regulations governing the billing of healthcare services. This includes understanding the scope of practice for different healthcare professionals and ensuring that services are provided within the authorized scope.

5. Example Cases

1. Case 1: A claim is denied because the provider did not obtain the necessary consent from the patient before performing the services. This highlights the importance of proper authorization processes.
2. Case 2: A claim adjustment occurs because the provider’s NPI was entered incorrectly on the claim, leading to billing issues. This emphasizes the need for accurate provider information.

Source: Remittance Advice Remark Codes