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CMS Pub. 100-04, ch. 1, § 10.1.9.9

A DME MAC receives a Paper Claim with Items or Services

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

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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