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CMS Pub. 100-04, ch. 1, § 10.1.9.3

A DME MAC Receives a Claim for Services that are in an A/B

activein force · 2026-08-25 – presentas-observed

MAC (B)’s Payment Jurisdiction

(Rev. 3510, Issued: 04-29-16, Effective: 10-01-16, Implementation; 10-03-16)

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.

The contractor shall use the following remittance advice messages and associated codes

when rejecting/denying claims under this policy. This CARC/RARC combination is

compliant with CAQH CORE Business Scenario Three.

Group Code: CO

CARC: 109

RARC: N104

MSN: N/A

History

(Rev. 3510, Issued: 04-29-16, Effective: 10-01-16, Implementation; 10-03-16)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
02b573514fac0b57f94ba93939de5df31dc1e2cee038ef24b4beefda6f57e08b
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CMS Pub. 100-04, ch. 1, § 10.1.9.3 — A DME MAC Receiv… · binding.law