MA14Remark Code (RARC)ActiveInformational Alert
MA14 Remark Code: Employer-Sponsored Plan Alert
The MA14 remark code indicates that the patient is enrolled in an employer-sponsored prepaid health plan. While the payer is covering this claim as a one-time exception, future claims for services outside the scope of the patient’s health plan will not be reimbursed.
What This Alert Tells You
The MA14 alert is informational and does not correspond to any specific adjustments or reason codes. It serves to notify providers about the patient's plan coverage status and expectations for future claims.
Common Scenarios
1A provider submits a claim for a service rendered to a patient who is part of an employer-sponsored health plan but is not covered under that plan's network.
→ The MA14 remark signals that while this claim is being paid, similar future claims may be denied if they fall outside the patient’s health plan coverage.
2A hospital bills for outpatient services provided to a patient, and the remittance advice includes the MA14 remark code.
→ The MA14 alert indicates that the hospital will receive payment for this service, but the payer warns that future claims for non-plan services will not be reimbursed.
3A specialty clinic receives an 835 remittance for a patient who is part of an employer-sponsored prepaid health plan, and it shows the MA14 remark code.
→ The MA14 remark informs the clinic that this payment is a one-time exception due to a lack of prior notification regarding the patient's plan restrictions.
What to Do
- Do not resubmit the claim, as it has been paid this time.
- Prepare for potential future denials on similar claims that fall outside the patient's plan coverage.
What to Check
- Verify the patient's eligibility and coverage details with the employer-sponsored health plan.
- Review any prior communications from the payer regarding coverage limitations for this patient.
- Check the specific services rendered against the plan’s covered services list.