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MA23 Remark Code: Demand Bill Approved on Review

MA23 means a demand bill, a claim the provider submitted at the patient's request even though the provider expected non-coverage, was approved after medical review. The payer found the services covered and processed them for payment.

Quick facts

Code
MA23 (RARC MA23)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Standard contractual adjustments apply to the approved services.
  • PR (Patient Responsibility): Only normal cost-sharing is the patient's responsibility now that the services are covered.
Official description
Demand bill approved as result of medical review.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA23 means

A demand bill is how a patient gets a formal decision when the provider thinks a service will not be covered. The provider issues an advance notice, the patient chooses to receive the service and asks that the claim be submitted, and the payer reviews it. MA23 tells you that review found the services covered.

This code is most familiar in Medicare institutional billing, such as skilled nursing and home health, where demand bills are part of the notice process.

What to do

  1. Post the payment and apply normal contractual adjustments.
  2. Recalculate the patient’s share. Only the PR amounts on the remittance are owed.
  3. Refund excess payments. If the patient paid under the advance notice, return what they paid beyond their cost-sharing.
  4. Note the outcome. The review result is useful when deciding whether similar future stays or services need an advance notice.

How to prevent unnecessary demand bills

When demand bills keep coming back approved, your non-coverage criteria may be too cautious. Review them against the payer’s coverage rules. Tracking outcomes over time is easier with an ERA Analyzer.

Codes that may appear with MA23

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The normal fee schedule adjustment on the approved services.
  • PR-1 (Deductible Amount): Deductible applied to the now-covered services.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): A medical necessity denial, the outcome the provider expected when it issued the advance notice.
  • MA59 (Alert: The patient overpaid you for these services.): The patient overpaid and must be refunded within 30 days.
  • MA10 (Alert: The patient's payment was in excess of the amount owed.): The patient's payment exceeded the amount owed and must be refunded.

MA23 FAQ

What is a demand bill?

When a provider believes Medicare will not cover a service and gives the patient an advance notice, the patient can still ask the provider to submit a claim. That claim is the demand bill, and it asks Medicare to make a formal coverage decision.

What if the patient already paid?

If the patient paid for the services expecting non-coverage, refund the amount beyond their cost-sharing now that the services are covered.

Does MA23 require any claim correction?

No. It reports a favourable outcome. Post the payment and adjust the patient's account.