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Procentive Knowledge Hub

Claim Adjustment Reasoning Codes (CARC)

Overview

Learn about the reasoning codes used in ERA's and where to find additional help.

Definitions

  • CARC: Claim Adjustment Reason Codes  communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code. 
  • RARC: Remittance Advice Remark Codes are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. 

CARC Example:


The CAS (CARC) line in the ERA is where you will see what code(s) the payer has sent back to Procentive.  

ERA Module.png

 Hover over the CARC number (45 in this example) and a box with a description for the code will appear.

Hover over CARC code in ERA.png

 Not all codes will have a reason when you hover (there are literally hundreds!)  However, your database will be set up with the most commonly used CARC's.

RARC Example:

If the payer has also sent back an RARC, you see a black note on your ERA. Hover over this black note to view the explanation for this code. 
 

remark code example.png
 

Additional help

A full list of these codes can be found through the following links.

CARC      http://www.wpc-edi.com/reference/cod...-reason-codes/

RARC      http://www.wpc-edi.com/reference/cod...-remark-codes/

If you are seeing a denial code on MN-ITS, you may find this link helpful as well as they also use Health Care Claim Status Codes.

Health Care Claim Status Codes convey the status of an entire claim or a specific service line.

http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-codes/

ML: Future link with more on the ERA rules that can be set up through the Change Rules link

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