M127Remark Code (RARC)Active
M127 Remark Code - Missing Patient Medical Record
The M127 remark code indicates that the payer requires a patient medical record for the service billed, and it was not provided. This remark supplements an adjustment already detailed by a Claim Adjustment Reason Code, emphasizing the need for documentation to support the claim.
How It Relates to the Denial
Typically, the M127 remark code accompanies adjustments related to claim denials or reductions where documentation is lacking. The combination signals that the payer needs further information to process the claim correctly.
Common Scenarios
1A provider submitted a claim for a surgical procedure, but the payment was reduced due to lack of supporting documentation. The remittance includes the M127 remark code.
→ In this case, the M127 remark indicates that the payer is missing the patient's medical record that justifies the surgical service, which led to the adjustment.
2A claim for a diagnostic test was denied, and the remittance shows the M127 remark along with a claim adjustment reason code indicating insufficient documentation.
→ The M127 remark here points out that the denial is specifically due to the absence of the patient's medical record needed to validate the test performed.
3An office visit claim was partially paid, with the remittance including the M127 remark code alongside a reason code for non-covered services.
→ This means the M127 remark is highlighting that the payer could not fully assess the claim due to missing medical record documentation.
What to Do
- Obtain the patient's medical record pertinent to the service in question.
- Submit the medical record to the payer for review to support the claim.
- Ensure any additional documentation requested by the payer is included with the resubmission.
What to Check
- Review the claim submission for any documentation that was originally included.
- Check the remittance advice for the accompanying claim adjustment reason code to understand the context of the M127 remark.
- Verify the patient's medical record is complete and accurately reflects the service provided.