RARC MA13
Alert about billing the patient
A warning that penalties may apply if the patient is billed for amounts not reported as their responsibility.
Why you actually get this
- The payer is flagging that an amount is a contractual adjustment rather than patient liability.
- A statement process that bills the balance after insurance without separating adjustments from patient responsibility.
How to check whether it’s correct
- 01Confirm which amounts carry the patient-responsibility group code and which do not.
- 02Ensure the patient statement reflects only genuine patient liability.
Rarely worth appealing
Not a denial and nothing to appeal. It matters because billing a patient for a contractual adjustment is a compliance problem, not merely an error — check the statement before it goes out.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Remittance Advice Remark Codes are External Code List 411, maintained by CMS and published by X12. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.