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MA96 Remark Code: Demo Claim, Patient Not in Managed Care

MA96 means the claim was rejected because it was coded as a Medicare Managed Care Demonstration claim, but the patient is not enrolled in a Medicare managed care plan. Rebill it under the patient's actual coverage.

Quick facts

Code
MA96 (RARC MA96)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim was rejected for a coding and eligibility mismatch. The provider corrects it; the patient is not billed for the rejection.
Official description
Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA96 means

MA96 is a Medicare rejection. The claim carried coding that identified it as part of a Medicare Managed Care Demonstration, but Medicare’s records show the patient is not enrolled in a Medicare managed care plan. Since the demonstration coding does not fit the patient, the claim cannot be processed as submitted.

Common causes

  • A demonstration identifier or contract number was applied by default to every claim from a clinic that participates in a demonstration.
  • The patient disenrolled from the managed care plan before the date of service.
  • The patient was never enrolled, and registration assumed coverage from a plan card.
  • Enrollment was pending and not yet effective on the date of service.

How to fix it

  1. Verify enrollment for the date of service through Medicare eligibility.
  2. Remove the demonstration coding if the patient is covered by original Medicare, and bill the claim normally.
  3. Resolve enrollment gaps with the patient and plan if they believe they are enrolled.
  4. Resubmit as a new claim, since rejected claims were not processed.

How to prevent it

Codes that may appear with MA96

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim has a submission or billing error, here demonstration coding that does not fit the patient.
  • CO-109 (Claim/service not covered by this payer/contractor.): The claim went to the wrong program or contractor and should be billed elsewhere.
  • MA97 (Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.): The demonstration contract or clinical trial number was missing or invalid.
  • MA73 (Informational remittance associated with a Medicare demonstration.): The reverse situation: no fee-for-service payment because the patient did elect managed care.
  • N30 (Patient ineligible for this service.): The patient is ineligible for the service billed.

MA96 FAQ

Is MA96 a denial?

The official text calls it a rejection. The claim was not adjudicated for payment, so correct and resubmit rather than appealing.

What coding marks a claim as a demonstration claim?

Typically a demonstration project identifier or contract number on the claim. Your Medicare contractor's instructions define what is used.

What if the patient says they are in a managed care plan?

Check eligibility for the date of service. If enrollment is confirmed there but not in Medicare's records, the patient or plan needs to resolve the enrollment.