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Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs and RARCs)--Effective 05 01

Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs and RARCs)--Effective 05 01 2025

Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs and RARCs)--Effective 05 01 Preview on Page 1

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The document outlines the Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs and RARCs) effective from May 1, 2018. It provides a comprehensive list of codes used to explain adjustments made to claims, detailing reasons for denials, missing information, billing errors, and other relevant remarks. Each code is associated with specific descriptions that clarify the nature of the claim issues, including missing provider identifiers, invalid formats, and maximum allowable limits for services. The document serves as a reference for healthcare providers and billing professionals to understand the rationale behind claim adjustments.

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Click ‘Get Form’ to open it in the editor.
Begin by reviewing the EOB codes listed in the document. Each code corresponds to specific reasons for claim adjustments or remarks.
Fill in the required fields, including the EOB code and its description, ensuring accuracy to avoid submission errors.
Utilize our platform's features to highlight any missing information or discrepancies noted in the adjustment reason codes.
Once completed, save your changes and utilize the signing feature if necessary before submitting your form.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are carc and rarc codes?

Remittance Advice Remark Codes (RARCs) 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. Each RARC identifies a specific message as shown in the Remittance Advice Remark Code List.

What is a CARC code 7?

Common Causes of CARC 7. Common causes of code 7 are: 1. Incorrect patient gender recorded: One of the common causes for code 7 is when the procedure or revenue code is inconsistent with the patients gender.

What is a remark code 51?

Remittance Advice Remark Codes (RARCs) may be used by plans and issuers to communicate information about claims to providers and facilities, subject to state law.

What is a carc and rarc code?

EFFECTIVE JULY 1, 2022, payers will be required to use the following Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) on an explanation of benefits/explanation of review (EOB/EOR) sent to a health care provider to object to payment of a medical bill.

What does carc mean?

Whats a CARC? CARC stands for Claim Adjustment Reason Code and provides the reason for a claim adjustment made by the payer. They help you understand why the claim amount differs from the billed amount.

What is CARC used for?

Claim Adjustment Reason Codes (CARC) codes indicate why a claim was not paid as per expectations. Typically, these codes are numeric and tells us about the adjustments made to the claims payment. This could be due to contractual obligations, patient responsibility, duplicate billing and many other reasons.

Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs and RARCs)--Effective 05 01 2025

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