US · guidance
CMS Pub. 100-04, ch. 17, § 100.8.3.1
Editing for CAP NOC Drugs
Should the A/B MAC (B) receive a CAP NOC code, but the description does not match a
CAP NOC drug on the approved list, 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
Two.
Group Code: CO
CARC: 16
RARC: N350
MSN: N/A
Should a non-CAP physician submit the CAP NOC code, 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 Two.
Group Code: CO
CARC: 16
RARC: N56
MSN: N/A
Should a CAP physician submit a J NOC code with a description of a CAP approved
NOC drug, 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 Two.
Group Code: CO
CARC: 16
RARC: N56
MSN: N/A
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
bc683f18b356001699e399cdec07a4bab989d3438d0a0a7ae8c86b9e77ead3c7
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