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MA11 Remark Code (Deactivated): Conditional Payment

MA11 meant the payment was conditional: if no-fault insurance, liability insurance, workers' compensation, the VA, or an employer group health plan also covered the claim, a refund might be due to Medicare. X12 deactivated it and suggested M32.

X12 deactivated RARCMA11 on January 31, 2004. Payers should no longer use it on new remittances, but it can still appear on older ERAs, corrected claims, and appeals.

Quick facts

Code
MA11 (RARC MA11)
Status
Deactivated StoppedJanuary 31, 2004 (in use since January 1, 1997).
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Accompanied paid lines; the conditional nature did not change who owed the balance at the time.
  • OA (Other Adjustment): Sometimes present with other adjustments on claims involving possible other coverage.
Official description
Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA11 meant

Remark MA11 appeared on Medicare payments that might later have to be returned. Medicare paid the claim, but warned that if another source was responsible, such as no-fault or liability insurance, workers’ compensation, the Department of Veterans Affairs, or an employer group health plan, Medicare might need a refund. It also asked the provider to report any such coverage.

What replaced it

X12’s note suggested M32. M32 is an active alert stating that the payment is conditional pending a decision by the patient’s primary payer and may be subject to refund. When Medicare believes another payer should be primary, it may use CARC OA-22, or CO-20 when a liability carrier is responsible.

If you still see MA11

It is found in older Medicare remittances. For any conditional payment, flag the account, update the patient’s Medicare Secondary Payer information, and watch for payment from the other source. If it arrives, refund the conditional amount according to Medicare’s instructions.

  • M32 (Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer.): The suggested replacement: alert that this is a conditional payment pending the primary payer's decision.
  • OA-22 (This care may be covered by another payer per coordination of benefits.): This care may be covered by another payer per coordination of benefits.
  • CO-20 (This injury/illness is covered by the liability carrier.): This injury or illness is covered by the liability carrier.

MA11 FAQ

What is a conditional payment?

A payment Medicare makes when another payer may be primary but has not paid promptly. Medicare pays for now and expects to be repaid if the other payer ends up responsible.

When might I have to refund Medicare?

If you later receive payment from the primary source, such as an auto or liability settlement or a group health plan, for the same services.