Skilled Nursing Facility (SNF)

CARC/RARC Description
CO-109 Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
N538 A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
N193 Alert: Specific federal/state/local program may cover this service through another payer.

Common Reasons for Message

  • The patient is in a skilled nursing facility (SNF) and the service being billed is the responsibility of the SNF's billing.

Next Step

  • Verify the service is not on File 1 or File 2 found on the CMS SNF Consolidated Billing webpage.
    • If the service is on File 2, a reopening can be performed to update appropriate procedure code or modifier(s).
  • Use the Noridian Medicare Portal eligibility function to verify the patient's inpatient and SNF status.
  • The provider will need to work with the SNF to receive payment for any services that are part of the SNF's responsibility.

Claim Submission Tips

  • Bill SNF if service is not on the File 1 - Part A Stay - Physician Services or File 2 - Part A Stay - Professional Components of Services to be Submitted with a 26 Modifier lists.

Resources

Last Updated Dec 12 , 2024