MA73Remark Code (RARC)Active
MA73 Remark Code - Medicare Demonstration Informational
The MA73 remark code indicates that the remittance is informational due to a Medicare demonstration. It specifies that no payment was made under fee-for-service Medicare because the patient has opted for managed care coverage.
How It Relates to the Denial
This remark code typically accompanies adjustments indicated by a Claim Adjustment Reason Code that deals with denied or reduced payments due to managed care enrollment. The combination signals that the patient’s choice of managed care affects the claim's payment status.
Common Scenarios
1A claim for a routine office visit was submitted, but the payment remittance returned with a reason code indicating a denial.
→ The MA73 remark code clarifies that the denial is due to the patient's election of managed care, which precludes fee-for-service Medicare payment for this visit.
2A physical therapy claim was submitted to Medicare, but the remittance shows a zero payment amount with an associated adjustment reason code.
→ The presence of the MA73 remark code suggests that the patient is enrolled in managed care, resulting in no fee-for-service Medicare payment for the therapy services.
3A hospital outpatient procedure was billed, but the remittance response included an adjustment indicating a denial of payment.
→ The MA73 remark code indicates that the denial is related to the patient's choice of managed care, explaining why there is no payment under traditional Medicare.
What to Do
- Confirm the patient's managed care election.
- Do not resubmit the claim to Medicare for fee-for-service payment, as it will not be covered.
- Consider billing the managed care plan if applicable.
What to Check
- Patient's insurance eligibility and benefits documentation.
- The claim adjustment reason code accompanying the MA73 remark code.
- Any prior communications with the patient regarding managed care enrollment.