US · guidance
CMS Pub. 100-04, ch. 1, § 10.1.9.3
A DME MAC Receives a Claim for Services that are in an A/B
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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