BILLING NEWS

Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), update July 1, 2012

For transaction 835 (Health Care Claim Payment/Advice) and standard paper remittance advice, valid Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) must be used to report payment adjustments, appeal rights, and related information.

New Codes ñ RARC:

Code Code NarrativeEffective Date
N547 A refund request (Frequency Type Code 8) was processed previously.3/6/2012
N548 Alert: Patient’s calendar year deductible has been met.3/6/2012
N549 Alert: Patient’s calendar year out-of-pocket maximum has been met.3/6/2012
N550 Alert: You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future. 3/6/2012

SOURCE: Source
INDUSTRY NEWS TAGS: CMS


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