How To Fix Remark Code M201 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code MA96 means that a claim has been rejected because it was coded as a Medicare Managed Care Demonstration, but the patient is not enrolled in a Medicare managed care plan. This code is used to indicate the reason for denial or adjustment of a claim related to Medicare managed care services.

1. Description

Remark Code MA96 indicates that a claim has been rejected because it was coded as a Medicare Managed Care Demonstration, but the patient is not enrolled in a Medicare managed care plan. The official description states: ‘Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.’ This remark code is specific to Medicare managed care services and highlights the importance of accurate coding and patient enrollment status.

2. Common Reasons

1. Incorrect coding as a Medicare Managed Care Demonstration: This may occur due to coding errors or confusion regarding the specific requirements for Medicare managed care services.
2. Patient not enrolled in a Medicare managed care plan: The patient’s enrollment status is crucial for determining eligibility and coverage for Medicare managed care services.
3. Lack of documentation supporting Medicare managed care enrollment: Insufficient or missing documentation can lead to claim denials or adjustments.
4. Failure to verify patient’s Medicare managed care plan: It is essential to confirm the patient’s enrollment in a Medicare managed care plan before submitting a claim.

3. Next Steps

1. Review the coding and billing for Medicare Managed Care Demonstration: Ensure that the claim is coded correctly as a Medicare Managed Care Demonstration and that the patient is enrolled in a Medicare managed care plan.
2. Verify the patient’s enrollment in a Medicare managed care plan: Confirm the patient’s enrollment status with the appropriate Medicare managed care organization.
3. Obtain and submit the necessary documentation: Gather any required documentation supporting the patient’s enrollment in a Medicare managed care plan and include it with the claim.
4. Appeal the claim if necessary: If the claim was rejected in error or there are extenuating circumstances, consider appealing the decision with the appropriate documentation and supporting evidence.

4. How To Avoid It

1. Ensure accurate coding for Medicare Managed Care Demonstration: Familiarize yourself with the specific coding requirements for Medicare managed care services and double-check the codes before submitting a claim.
2. Verify patient’s enrollment in a Medicare managed care plan: Confirm the patient’s enrollment status with the Medicare managed care organization before providing services.
3. Maintain proper documentation: Keep thorough and accurate records of the patient’s enrollment in a Medicare managed care plan and any related documentation.
4. Stay updated on Medicare managed care policies: Stay informed about any changes or updates to Medicare managed care policies to ensure compliance and accurate billing.

5. Example Cases

1. Case 1: A claim for Medicare managed care services is rejected because the patient was not enrolled in a Medicare managed care plan, emphasizing the importance of verifying enrollment status.
2. Case 2: A claim adjustment occurs due to incorrect coding as a Medicare Managed Care Demonstration, highlighting the need for accurate coding practices.

Source: Remittance Advice Remark Codes