RARC M86: Service denied because payment already made for same/similar procedure within set time frame.
Same service was paid within a frequency window. Plan considers this a duplicate.
What it means
The official X12 description: “Service denied because payment already made for same/similar procedure within set time frame.”
In plain language: Same service was paid within a frequency window. Plan considers this a duplicate.
What to do
Check for prior payment of same procedure. If services were clinically distinct, appeal with documentation; otherwise no action.
Frequently asked questions
What does RARC M86 mean?
Service denied because payment already made for same/similar procedure within set time frame. In plain language: Same service was paid within a frequency window. Plan considers this a duplicate.
What should I do when I see RARC M86?
Check for prior payment of same procedure. If services were clinically distinct, appeal with documentation; otherwise no action.
Commonly paired CARC codes
Sources
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