Official X12 description
“Missing/incomplete/invalid ordering provider name.”
Source: X12 Remittance Advice Remark Codes. X12 publishes and maintains the RARC set; always verify against the current release before building a claim workflow.
Paired CARC codes
RARC N264 almost never appears alone — it accompanies one of the CARCs below on the same 835 remittance line. Fix the CARC and the RARC typically clears; the RARC alone is informational.
CARCs CAQH CORE pairs with RARC N264
Under the CAQH CORE Payment and Remittance Uniform Use rule, a health plan that reports remark code N264 on an 835 should pair it with one of the 1 claim adjustment reason code below, with the listed group code, for the business scenario 2 (Missing, invalid or incomplete data from the submitted claim). A remark paired outside this list is itself a compliance question to raise with the payer.
| CARC | Group code | Scenario |
|---|---|---|
| 16 | CO or PI | 2: Missing, invalid or incomplete data from the submitted claim |
The CMS data behind RARC N264
On Medicare Part B lab and imaging claims and DMEPOS claims, N264 with N575 and CARC 16 is the name-mismatch result of the ordering and referring edit: the first four letters of the ordering or referring practitioner's last name on the claim do not match the enrollment record (CMS change request 8356). Confirm the NPI is the practitioner's individual NPI and is in the Order and Referring file, then correct the name and resubmit.
What RARC N264 actually means
RARC N264 flags missing/invalid ordering provider name on the claim — a companion to N265 for NPI. Correct and rebill.
Common root causes
- Ordering provider name blank or mismatched to NPI.
Prevention checklist
- Order-to-name automation at EHR.
Resolution & appeal strategy — step by step
Because RARC N264 is supplemental to a CARC, the resolution path usually starts by fixing the underlying adjustment reason. A formal appeal of the RARC alone is rarely necessary.
- 1Correct name and resubmit.
Sample reconsideration language referencing RARC N264
Edit the bracketed fields before sending. Payer-specific reconsideration forms are often required — check the provider portal first.
How common is RARC N264?
Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).
How QuickRCM handles RARC N264
QuickRCM reads RARC N264 alongside its paired CARC in the 835 LQ segment and routes the line to the correct worker queue with the right documentation already attached:
- Denial routing rules tuned to the CARC+RARC pair — the paired combination tells QuickRCM which documentation the payer will accept.
- Reconsideration template for this exact remark code pulls the supporting facts from the claim automatically.
- Pre-submission scrubs that catch the preventable drivers surfaced on this page before the 837 leaves the clearinghouse.
Frequently asked questions — RARC N264
What does RARC N264 mean?
RARC N264 is an X12 Remittance Advice Remark Code. The official X12 definition is: "Missing/incomplete/invalid ordering provider name." It is supplemental to a Claim Adjustment Reason Code (CARC) on the same 835 line.
Which CARC is paired with RARC N264?
RARC N264 is most commonly paired with CARC 16, CARC 183, CARC 206. The CARC is the financial adjustment reason; the RARC is the informational remark. Fix the paired CARC first — the RARC usually clears with the corrected claim.
How do I resolve a RARC N264 remark on a remit?
Start from the root cause: Ordering provider name blank or mismatched to NPI. First step: Correct name and resubmit. Because RARCs are supplemental, the resolution is almost always to address the paired CARC rather than appeal the RARC alone.
Where does RARC N264 appear on the 835 ERA?
RARC N264 is carried on the 835 Loop 2110 LQ segment alongside the CARC in the CAS segment of the same service line. The code and its X12 description also print on the paper EOB in the "Remark Code" or "Remark" column next to the corresponding denial or adjustment reason.
Is RARC N264 the same as ICD-10 code N264?
No. RARC N264 is a remittance-advice remark code published by X12 and carried on the 835. Any ICD-10 code with the same letters and digits is a diagnosis code on the 837 HI segment — a completely different code set maintained by the WHO/CMS. Use the transaction context (835 = RARC; 837 = ICD-10) to disambiguate.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. X12 code descriptors are maintained by the X12 External Code Lists; always verify against the current X12 release and the payer's own published policy before submitting or appealing a claim.