How To Fix Remark Code M39 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code M45 means that there are missing, incomplete, or invalid occurrence code(s) on the claim. This code is often used by healthcare providers and insurance companies to indicate the reason for denial or adjustment of a claim due to issues with occurrence codes.

1. Description

Remark Code M45 indicates that there are missing, incomplete, or invalid occurrence code(s) on the claim. The official description states: ‘Missing/incomplete/invalid occurrence code(s).’ Occurrence codes are used to provide additional information about specific events or circumstances related to the claim. These codes play a crucial role in accurate billing and reimbursement processes.

2. Common Reasons

1. Missing occurrence code(s): This may occur when the necessary occurrence code(s) are not included on the claim. It is important to ensure that all relevant occurrence codes are provided to support the services rendered.
2. Incomplete occurrence code(s): Incomplete occurrence codes may occur when the required information is not fully provided. This can lead to claim denials or adjustments as the incomplete codes may not provide sufficient details for proper billing.
3. Invalid occurrence code(s): Invalid occurrence codes may occur when incorrect or unrecognized codes are used. It is essential to use valid occurrence codes that are recognized by the payer to ensure accurate processing of the claim.

3. Next Steps

1. Review the claim for missing occurrence code(s): Carefully examine the claim to identify any missing occurrence codes. Ensure that all relevant occurrence codes are included to provide complete information.
2. Verify the completeness of occurrence code(s): Double-check that all required information is provided for each occurrence code. This may involve reviewing documentation or consulting coding guidelines to ensure accuracy.
3. Correct any invalid occurrence code(s): If invalid occurrence codes are identified, replace them with valid codes recognized by the payer. This may require referring to the payer’s code set or seeking clarification from the payer directly.

4. How To Avoid It

1. Ensure all occurrence code(s) are included: Develop a thorough understanding of the required occurrence codes for different types of services and ensure they are consistently included on the claim.
2. Provide complete and accurate occurrence code(s) information: Take the time to gather all necessary information for each occurrence code and ensure it is accurately documented on the claim. This includes dates, descriptions, and any other required details.
3. Stay updated with payer requirements: Regularly review payer-specific guidelines and updates to ensure compliance with their specific occurrence code requirements. This can help avoid using invalid or outdated codes.

5. Example Cases

1. Case 1: A claim is denied because the required occurrence code for a specific procedure was missing. This emphasizes the importance of including all necessary occurrence codes to support the services provided.
2. Case 2: A claim adjustment occurs due to incomplete occurrence code(s) that did not provide sufficient information for proper billing. This highlights the need for accurate and complete occurrence code documentation.

Source: Remittance Advice Remark Codes