MA16Remark Code (RARC)Active
MA16 Remark Code - Patient Covered by Black Lung Program
The MA16 remark code indicates that the patient is covered by the Black Lung Program. It instructs billers to redirect the claim to the Department of Labor's Federal Black Lung Program for processing.
How It Relates to the Denial
The MA16 remark typically accompanies adjustment reason codes that indicate a claim is not payable by the current payer because the patient has coverage under a specific federal program. This combination signals that the claim needs to be submitted to a different entity for payment.
Common Scenarios
1A provider submits a claim for respiratory therapy services for a patient with a history of black lung disease. The remittance advice returns with an adjustment reason indicating non-coverage by the payer.
→ The MA16 remark clarifies that the claim should not be processed by the current payer due to the patient's eligibility for the Black Lung Program, directing the biller to submit the claim to the appropriate federal program.
2A clinic bills for a diagnostic test performed on a patient who is a coal miner. The remittance shows a denial with an adjustment reason code stating the service is not covered.
→ The MA16 remark indicates that the patient qualifies for benefits under the Black Lung Program and that the clinic should send the claim to the Department of Labor for resolution.
3A hospital submits a claim for inpatient services rendered to a patient with black lung disease. The claim is denied with a reason code related to coverage issues.
→ The presence of the MA16 remark means the hospital must redirect the claim to the Federal Black Lung Program, as the patient has coverage under this specific federal program.
What to Do
- Redirect the claim to the Department of Labor, Federal Black Lung Program, at the specified address.
- Ensure all necessary patient information is included with the resubmission to avoid further delays.
What to Check
- Verify the patient's coverage under the Black Lung Program through eligibility records.
- Review the initial claim submission for accuracy in coding and documentation.
- Check the remittance advice for any accompanying reason codes that may provide additional context.