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MA14 Remark Code: One-Time Payment Outside Prepaid Plan

MA14 is an alert. The patient is a member of an employer-sponsored prepaid health plan, and services from outside that plan are not covered. Because you had not been told before, the payer paid this time, but it will not pay you for non-plan services in the future.

Quick facts

Code
MA14 (RARC MA14)
Status
Active In use since January 1, 1997; last modified August 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any adjustment on this claim follows normal rules. MA14 itself does not reduce the payment; it warns about later claims.
Official description
Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA14 means

MA14 is a one-time courtesy with a warning attached. The payer found that the patient belongs to an employer-sponsored prepaid health plan, which normally covers services only from providers inside that plan. Since your office had not been notified, the payer paid this claim anyway. The alert puts you on notice that similar claims will not be paid going forward.

Nothing needs correcting on this claim. The action is about the patient’s future visits.

What to do

  1. Post the payment normally. Treat the adjustments on the claim according to their group and reason codes.
  2. Update the patient’s coverage record to show the prepaid plan, including its name and member ID.
  3. Talk to the patient. Explain that future services from your practice may not be covered and discuss referral to plan providers.
  4. Check before scheduling. Verify coverage for this patient before each future visit.

Coverage checks at intake prevent this kind of surprise; see eligibility and COB denials.

Codes that may appear with MA14

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): A routine allowed-amount reduction may appear on the one-time paid claim.
  • OA-24 (Charges are covered under a capitation agreement/managed care plan.): On later claims, services may be denied as covered under a capitation or managed care arrangement.
  • MA26 (Alert: Our records indicate that you were previously informed of this rule.): An alert that you were previously informed of a rule, which is what later non-plan claims may carry.
  • CO-242 (Services not provided by network/primary care providers.): Services not provided by network or primary care providers.
  • CO-256 (Service not payable per managed care contract.): Service not payable under the managed care contract.

MA14 FAQ

Do I need to return this payment?

No. MA14 says the payer is paying this time because you were not previously notified. The warning applies to future claims.

What happens if I see the patient again?

Services outside the prepaid plan are not expected to be paid. Refer the patient to plan providers or bill the plan according to its rules.

Should I tell the patient?

Yes. The patient may not realise their plan restricts them to its own providers. A conversation now avoids an unpaid bill later.