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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

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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 or modifications in payments. Each code is associated with specific descriptions that clarify the nature of the claim issues, such as missing information, invalid formats, or non-covered services. The document serves as a reference for healthcare providers and billing professionals to understand the rationale behind claim adjustments.

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How are remittance advice remark codes (RARCs) used in a claim adjustment?

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.

What is RARC and CARC codes in medical billing?

CARCs Are Generic, While RARCs Are Specific Claim Adjustment Reason Codes offer general explanations about the denial or payment adjustment. For example, exact duplicate claim/service or expenses incurred prior to coverage.

What does CARC stand for in medical billing?

Claim Adjustment Reason Codes (CARC)

What is CR 50 denial code?

Denial code 50 means the service is not covered because its not considered medically necessary by the insurance company.

What is the meaning of 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.