Incarcerated Beneficiary

CARC/RARC Description
N103 Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.
OA-258 Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service.

 

Common Reasons for Message

  • Generally, Medicare will not pay for medical services furnished to beneficiaries who are incarcerated or under penal custody

Next Step

  • Noridian Medicare Portal users can access NMP to view eligibility information including ineligible periods
  • Request beneficiary contact Social Security Administration (SSA) to correct or remove dates of beneficiary's incarceration period
  • Check with State Department of Corrections regarding payment
  • If claim denied in error, complete a Self-Service Reopening in NMP or request a Telephone or Written Reopening to reprocess the claim

Claim Submission Tips

 

Last Updated May 21, 2018