Medicaid Secondary Claims Submitted with CARC Code 97CARC-Update

The NC Division of Medical Assistance (DMA) is suspending the new Medicaid secondary claims editing related to Claim Adjustment Reason Code (CARC) 97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated) that was communicated in the May 2017 Medicaid Special Bulletin. For 90 days, beginning Sept. 25, 2017, NCTracks will allow the claim or claim line billed with primary payer CARC 97 to process and adjudicate without denying the claim or claim line with Explanation of Benefits (EOB) 01843 – MEDICAID DENIED DUE TO INDICATION OF PRIOR PAYER DENIAL. This is a temporary change and will be applicable for all service dates while implemented. Before the 90-day time frame expires, a follow-up communication from DMA will be posted. It is very important the primary payer Claim Adjustment Group Code (CAGC) and CARC information be submitted to NCTracks, either by X12 batch transaction or via Provider portal, exactly as it appears on the primary payer EOB/Remittance. This includes accurately submitting codes at the header or detail claim line.