MSN/Remittance Messages for Immunosuppressive Drugs

80.3.2 - MSN/Remittance Messages for Immunosuppressive Drugs (Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17) Remittance codes/messages for denied Immunosuppressive Drugs are as follows: If the immunosuppressive drug is not approved by the FDA, contractor shall deny the claim. The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three. Group Code: CO CARC: 114 RARC: N.A MSN: 6.2 If the claim is denied because the benefit period has expired or because of the 30 day limitation, the contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three. Group Code: CO CARC: 35 RARC: N.A MSN: 4.3 If the claim is denied for the immunosuppressive drug because a transplant was not covered, the contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two. Group Code: CO CARC: 107 RARC: N.A MSN: N/A