US · guidance
CMS Pub. 100-04, ch. 1, § 10.1.9.9
A DME MAC receives a Paper Claim with Items or Services
that are in Another DME MAC's Payment Jurisdiction
(Rev. 3510, Issued: 04-29-16, Effective: 10-01-16, Implementation; 10-03-16)
When a DME MAC receives a claim submitted on the Form CMS -1500 for Medicare
payment that should be processed by a DME MAC but was sent to the wrong DME MAC,
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
DME MACs shall continue to follow existing procedures for misdirected beneficiary-submitted claims and electronic claims.
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
bc82849cfa40d023f7d4803098fcfc2bd3c0a6080fa05b30e941e7d65f74be50
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