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MA64 Remark Code: Payer Is Third, Needs Prior Payments

MA64 means the payer's records show it is the tertiary payer. It will not process the claim until it receives the payment information (remittances or EOBs) from both the primary and secondary payers.

Quick facts

Code
MA64 (RARC MA64)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim is held back as a provider-side coordination of benefits issue. Do not bill the patient; submit the missing prior-payer information.
  • OA (Other Adjustment): Some payers report the coordination adjustment under Other Adjustments, since the amount may be covered once the prior payers' results are known.
Official description
Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA64 means

Coordination of benefits (COB) puts a patient’s coverages in order: primary pays first, secondary pays next, and a third plan pays last. MA64 tells you this payer’s records put it in that third position. It will not adjudicate the claim until it can see how both the primary and the secondary payer handled it, because its payment depends on what they already paid.

The claim usually comes back with CARC 22 (covered by another payer) or CARC 16 (missing information).

Common causes

  • The claim was sent to the tertiary payer before the primary and secondary claims were finalized.
  • The claim went out with prior-payer information for only one payer, not both.
  • The patient has only two coverages, but the payer’s COB file still lists an old or terminated plan.
  • The order of coverage was entered incorrectly at registration, so claims were routed in the wrong sequence.

How to fix it

  1. Confirm all active coverages with the patient and check eligibility with each payer.
  2. Work the claim in order. Make sure the primary and secondary claims are adjudicated before billing the third payer.
  3. Resubmit with both prior payers’ results. On an 837, report each other payer’s paid amount and adjustments; on paper, attach both EOBs and complete CMS-1500 items 9-9d and 11d.
  4. If the COB record is wrong, ask the patient to contact the payer to update it, then rebill once the record is corrected.

See eligibility and COB denials for a deeper look at sequencing problems.

How to prevent it

  • Ask about every active coverage at each visit, not only at the first registration.
  • Store coverage order in your system and hold tertiary claims until secondary remittances post.
  • Flag patients with three coverages so billers know to route claims in sequence.

Codes that may appear with MA64

  • OA-22 (This care may be covered by another payer per coordination of benefits.): The care may be covered by another payer per coordination of benefits, and MA64 specifies that two payers come first.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information needed to adjudicate, here the prior payers' payment data.
  • MA04 (Secondary payment cannot be considered without the identity of or payment information from the primary payer.): The two-payer version: the payer is secondary and needs the primary payer's information.
  • N4 (Missing/Incomplete/Invalid prior Insurance Carrier(s)): Asks specifically for the prior insurance carrier's EOB.
  • MA85Deactivated (Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance…): Says a primary payer exists but the other-insurance fields on the claim were left blank.
  • MA83 (Did not indicate whether we are the primary or secondary payer.): The claim did not indicate whether this payer is primary or secondary.

MA64 FAQ

What if the patient does not actually have three coverages?

Have the patient confirm their coverage, then ask the payer to update its coordination of benefits record. Some payers require the member to complete a COB questionnaire before the record changes.

Do I need both prior EOBs or just one?

MA64 asks for payment information from both the primary and the secondary payer. Send the adjudication results from each, including any denials.

Can a tertiary claim go electronically?

Usually yes. The 837 supports multiple other-payer loops, so each prior payer's paid amount and adjustments can be reported. Check whether your payer or clearinghouse supports tertiary electronic claims.