Glossary term
CARC (claim adjustment reason code)
Short answer
A CARC, or claim adjustment reason code, explains why a payment differs from the billed amount. Each CARC is paired with a group code such as CO (contractual obligation), PR (patient responsibility), or OA (other adjustment). For example, CO-45 means the charge exceeded the fee schedule. CARCs appear on 835 ERAs and on EOBs.
Who maintains CARCs?
CARCs are maintained by a code committee and published by X12. The list is updated periodically, so codes can be added, revised, or retired over time.
How are CARCs different from RARCs?
A CARC states the reason for the adjustment. A RARC adds supplemental detail, such as what information is missing or what the provider should do next.
Which terms relate to CARC (claim adjustment reason code)?
Which guides cover this term?
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