MA27Remark Code (RARC)Active
MA27 Remark Code - Missing Entitlement Info Explained
The MA27 remark code indicates that there is a missing, incomplete, or invalid entitlement number or name listed on the claim. This remark supplements a Claim Adjustment Reason Code that describes the adjustment related to the entitlement information provided.
How It Relates to the Denial
The MA27 remark code typically accompanies reason codes that indicate a denial or adjustment due to issues with patient eligibility, specifically regarding entitlement details. Together, they signal that the claim cannot be processed due to inaccuracies in the identifying information.
Common Scenarios
1A claim for a surgical procedure was submitted, but the remittance returned with an adjustment indicating patient eligibility issues.
→ The MA27 remark suggests that the entitlement number or the patient's name did not match the payer's records, leading to the denial of the claim.
2A billing office received a denial for a therapy session, stating that the patient is not eligible for coverage, and the remittance included the MA27 remark code.
→ This indicates that the claim was rejected due to missing or incorrect entitlement information, and the biller needs to verify the details provided.
3An outpatient service claim was processed but denied with a note about invalid patient information and the MA27 remark accompanying it.
→ The MA27 remark points to a discrepancy with the entitlement number or name, which needs to be corrected for the claim to be reconsidered.
What to Do
- Verify the entitlement number provided on the claim against the patient’s insurance information.
- Ensure the patient’s name is accurately represented on the claim as it appears on their insurance card.
- Correct any discrepancies and resubmit the claim with the updated information.
What to Check
- The patient's insurance card for the correct entitlement number and name.
- The eligibility response from the payer to confirm the details on file.
- The claim form submitted to ensure it matches the patient's information accurately.