M115Remark Code (RARC)Active
M115 Remark Code - Denial for Non-Contract Supplier
The M115 remark code indicates that the billed item has been denied because it was provided to a patient by a supplier who is either non-contract or non-demonstration. This remark supplements an adjustment already noted by a Claim Adjustment Reason Code, clarifying the reason for the denial related to supplier status.
How It Relates to the Denial
The M115 remark code typically accompanies adjustment reason codes that indicate a denial related to provider or supplier network participation. This combination signals that the claim was denied due to the provider's contractual status with the payer.
Common Scenarios
1A provider billed for a durable medical equipment (DME) item, but the claim returned with a denial indicating it was supplied by a non-contract supplier.
→ In this case, the M115 remark code clarifies that the denial stems from the supplier's lack of a contract with the payer, reinforcing the adjustment reason code that was issued.
2A patient received services from an out-of-network supplier, and the remittance included a denial for the billed service with a supplemental M115 remark code.
→ The M115 remark code here indicates that the service was denied due to the supplier's non-contract status, which the accompanying reason code also reflects.
3A claim for a medical supply was submitted, and the remittance response included a denial with the M115 remark, indicating a supplier issue.
→ This remark indicates that the denial is specifically because the supplier is not a contracted provider with the payer, as noted by the related adjustment reason code.
What to Do
- Verify the supplier's contract status with the payer.
- Consider resubmitting the claim with services from a contracted supplier if applicable.
- Review the patient’s eligibility and benefits to ensure coverage for the supplier's services.
What to Check
- The provider's participation status with the payer.
- The specific adjustment reason code that accompanies the M115 remark.
- Documentation regarding the supplier's contractual agreements.