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RARC N97 · Remittance Advice Remark Code

RARC N97 Remark Code: Patients with stress incontinence, urinary obstruction, and specific neurologic…

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

Not an ICD-10 code. RARC N97 is a remittance-advice remark code published by X12 and carried on the 835 LQ segment. Any ICD-10 code with the same letters and digits (e.g., ICD-10 M15 osteoarthritis, N130 other urinary tract disorders) is a separate, unrelated code set used in diagnoses on the 837. Confirm the context before acting on this page.

TL;DR

RARC N97 (X12 Patients with stress incontinence, urinary obstruction, and specific neurologic diseases that affec…). Commonly paired with CARC 50, CARC 125. RARC N97 denies bladder-stimulation device coverage because clinical criteria not met.

Official X12 description

“Patients with stress incontinence, urinary obstruction, and specific neurologic diseases that affect the function of the bladder are eligible for the pump. Documentation does not meet the criteria.”

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 N97 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.

Paired CARCWhat the CARC means
CARC 50These are non-covered services because this is not deemed a 'medical necessity' by the payer.
CARC 125Submission/billing error(s). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

What RARC N97 actually means

RARC N97 denies bladder-stimulation device coverage because clinical criteria not met. Appeal with detailed clinical documentation meeting criteria.

Common root causes

  • Clinical criteria for bladder-pump coverage unmet in documentation.

Prevention checklist

  • Specialty documentation template covering payer criteria.

Resolution & appeal strategy — step by step

Because RARC N97 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.

  1. 1Appeal with complete clinical documentation.
Sample reconsideration language referencing RARC N97
[Provider letterhead] Re: Reconsideration — Claim #{claim_number}, CARC 50 / RARC N97 Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} The 835 remittance on {remittance_date} carried RARC N97: "Patients with stress incontinence, urinary obstruction, and specific neurologic diseases that affect the function of the bladder are eligible for the pump. Documentation does not…" We request reconsideration. The attached documentation rebuts the remark code: 1. [State the fact that rebuts the remark — authorization number, primary 835, modifier rationale, LCD citation, etc.] 2. [Reference the paired CARC and the corresponding fix] 3. [Attach the supporting document listed in step 1] Attached: {list supporting documents} Please process this line under the member's benefits. Contact the billing office at {provider_phone} for questions. Sincerely, {billing_manager_name}, {credentials}

Edit the bracketed fields before sending. Payer-specific reconsideration forms are often required — check the provider portal first.

How common is RARC N97?

Platform frequency
Pending ETL

Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).

How QuickRCM handles RARC N97

QuickRCM reads RARC N97 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.
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Frequently asked questions — RARC N97

What does RARC N97 mean?

RARC N97 is an X12 Remittance Advice Remark Code. The official X12 definition is: "Patients with stress incontinence, urinary obstruction, and specific neurologic diseases that affect the function of the bladder are eligible for the pump. Documentation does not meet the criteria." It is supplemental to a Claim Adjustment Reason Code (CARC) on the same 835 line.

Which CARC is paired with RARC N97?

RARC N97 is most commonly paired with CARC 50, CARC 125. 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 N97 remark on a remit?

Start from the root cause: Clinical criteria for bladder-pump coverage unmet in documentation. First step: Appeal with complete clinical documentation. Because RARCs are supplemental, the resolution is almost always to address the paired CARC rather than appeal the RARC alone.

Where does RARC N97 appear on the 835 ERA?

RARC N97 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 N97 the same as ICD-10 code N97?

No. RARC N97 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.