Wednesday, July 6, 2016

Claim submitted to other state Medicare - Code MA130, CARC 109, N104 AND N127



Local B/MAC/Carrier Receives a Claim for Services that are in Another Local B/MAC/Carrier’s Payment Jurisdiction


When a local contractor (Part B MAC or carrier) receives a CMS-1500 or electronic claim for Medicare payment for items/services furnished outside of its payment jurisdiction, the claim shall be returned as unprocessable.

NOTE: This instruction also applies to claims for DMEPOS items/services that are appropriately billed to the B MAC/carrier, but are billed to the wrong B MAC/carrier payment jurisdiction.

Use the following messages for claims indicated above except for claims that are identified as UMWA or RRB claims:

Claim Adjustment Reason Code (CARC) 109 – Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

Remittance Advice Remark Code (RARC) N104 - This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS Web site at www.cms.gov.

RARC MA130 - Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information


 A Local B/MAC/Carrier Receives a Claim for Services that are in A DME MAC’s Payment Jurisdiction

When a local contractor (Part B MAC or carrier) receives a CMS-1500 or electronic claim for Medicare payment for items/services that are in a DME MAC’s payment jurisdiction, the claim shall be returned as unprocessable.

Use the following messages for claims indicated above except for claims that are identified as UMWA or RRB claims:

CARC 109 – Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

RARC N104 - This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS Web site at www.cms.gov.

RARC MA130 - Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.


- A DME MAC Receives a Claim for Services that are in A Local B/MAC/Carrier’s Payment Jurisdiction

When a local DME MAC receives a CMS-1500 or electronic claim for Medicare payment for items/services that are in a Part B MAC or carrier’s payment jurisdiction, the claim shall be returned as unprocessable.

Use the following messages for claims indicated above except for claims that are identified as UMWA claims:

CARC 109 – Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

RARC N104 - This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS Web site at www.cms.gov.

RARC MA130 - Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.


 A Local B/MAC/Carrier Receives a Claim for an RRB Beneficiary

When a local contractor (Part B MAC or carrier) receives a Form CMS-1500 or electronic claim that is identified as a RRB claim for Medicare payment that should be processed by the RRB contractor, the claim shall be returned as unprocessable.

Use the following messages:

CARC 109 – Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

RARC N105 - This is a misdirected claim/service for a RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 866-749-4301 for RRB EDI information for electronic claims processing.

RARC MA130 - Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is  unprocessable. Please submit a new claim with the complete/correct information.

NOTE: CMS requests that when RRB receives a claim that is not for an RRB beneficiary that they return the claim to the sender and notify them that the claim must be submitted to the local contractor (Part B MAC or carrier) or DME MAC for processing.


- A Local B/MAC/Carrier/DME MAC Receives a Claim for a UMWA Beneficiary

When a local contractor (Part B MAC or carrier/DME MAC) receives a Form CMS-1500 or electronic claim that is identified as a UMWA claim for Medicare payment that should be processed by the UMWA, the claim shall be returned as unprocessable.

Use the following messages:

CARC 109 - Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

RARC N127 – This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.

RARC MA130 - Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

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