Medicare Advantage Plan

CARC/RARC Description
CO-24 Charges are covered under a capitation agreement/managed care plan.

 

Common Reasons for Message

  • Patient enrolled in a Medicare Advantage (MA) plan on date of service
    • Certain MA plans take place of Original Fee-For-Service Medicare
  • Patient's Common Working File (CWF) file has not been updated to show disenrollment from MA plan
  • Patient is enrolled in an MA plan and also elected hospice
    • Original Medicare covers attending physician services and all care unrelated to terminal illness
    • Appropriate modifier(s) is missing from claim
  • Patient enrolled in MA plan and also in a clinical trial
    • Original Medicare covers routine costs of services for qualifying clinical trials

Next Step

  • Verify patient's eligibility via Interactive Voice Response (IVR) or the Noridian Meidcare Portal
    • If MA plan valid, bill services to appropriate insurer
    • If MA plan has been updated and is no longer valid for date of service, submit new claim
  • Refile claim with appropriate modifiers
    • Modifier GV - Attending physician is not employed or paid under agreement by the patient's Hospice provider
    • Modifier GW - Condition not related to the patient's terminal condition
    • Modifier Q0 - Investigational clinical service provided in a clinical research study that is in an approved clinical research study
    • Modifier Q1 - Routine clinical service provided in a clinical research study that is in an approved clinical research study
  • Submit a Reopening request,
    • Add appropriate modifier(s), if time limit for filing claim has expired
    • If MA plan was not valid, request reprocessing of claim

Claim Submission Tips

  • Prior to rendering services, obtain patient's health insurance card

View reason code list, return to Reason Code Guidance page

 

Last Updated Nov 15, 2017