US · guidance
CMS Pub. 100-04, ch. 17, § 100.5.2
Denials For Reasons Other Than Medical Necessity
If the designated A/B MAC (B) denies the lines due to other reason, 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: 96
RARC: RARC most descriptive of ‘other’ denial reason. CARC 96 requires an
accompanying RARC.
MSN: 16.10
History
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
76a7ab54e2e25a81948c14dbfd46e97948130281db0d9860d0481720a90e0b34
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