MA60Remark Code (RARC)Active
MA60 Remark Code - Patient Relationship Issues
The MA60 remark code indicates that there is a missing, incomplete, or invalid patient relationship to the insured. This remark supplements a Claim Adjustment Reason Code, providing additional context regarding the patient’s relationship to the policyholder.
How It Relates to the Denial
The MA60 remark typically accompanies adjustment reason codes that pertain to eligibility or coverage issues. This combination signals that the payer requires clarification on how the patient is related to the insured individual in order to process the claim correctly.
Common Scenarios
1A claim for a pediatric visit is submitted, but the remittance advises that the claim is adjusted due to patient eligibility issues.
→ The MA60 remark suggests that the payer could not verify the relationship of the child to the parent or guardian listed as the insured, indicating a need for clarification.
2A facility submits a claim for a patient who is the spouse of the insured, but the remittance shows an adjustment related to coverage.
→ In this case, the MA60 remark points out that the payer could not confirm the spouse's relationship to the insured, leading to the adjustment.
3A claim for a specialist visit is denied due to coverage issues, and the remittance includes the MA60 remark along with a reason code for the denial.
→ The MA60 remark highlights that the payer requires more information regarding the patient's relationship to the insured to resolve the coverage denial.
What to Do
- Verify the patient’s relationship to the insured as listed on the claim.
- Correct any inaccuracies in the patient’s relationship information and resubmit if necessary.
- Ensure that all relevant documentation supporting the patient’s relationship is attached if appealing the adjustment.
What to Check
- The patient’s insurance card for accurate relationship details.
- The claim form to ensure the correct relationship was submitted.
- Any notes or documentation related to the patient’s relationship to the insured, especially if it differs from what was submitted.