A Local B/MAC/Carrier Receives a Claim for an RRB Beneficiary (Rev. 2474, Issued: 05-18-12)

by  Find-A-Code
July 9th, 2015

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/Pub 100-04 Medicare Claims Processing Manualor 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.

References:

A Local B/MAC/Carrier Receives a Claim for an RRB Beneficiary (Rev. 2474, Issued: 05-18-12). (2015, July 9). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/a-local-b-mac-carrier-receives-a-claim-for-an-rrb-beneficiary-rev-2474-issued-05-18-12-27180.html

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