When insurance carriers send payment and adjustment information, either on an EOB or an ERA, they often include a code with a small message. These codes are known as CARC values, or Claim Adjustment Reason Codes, and they are an industry-wide standard.
CARC values can include a code, an amount, and an additional group code.
Partner stores and displays CARC information to help you understand charge history, communicate adjustment information on patient bills, and submit secondary claims.
How Does It All Work? (An Example)
You may see a 45 on your EOB or ERA, with a note indicating that 45 means, “Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.” Number 45 is the most common CARC value, and it indicates that the payor has adjusted your charge to their pay schedule.
If Partner received the remittance electronically, it will record “45” when posting the payment and adjustment.
If posting manually, you can enter 45 into pip, along with a CARC amount and group, if provided.
You will be able to review the CARC information in oops, the Account History (tater) report, and on personal bills.
What Are Some Common CARCs?
While there are hundreds of CARC values, the common ones comprise most of the codes you will receive. Here are the top nine:
(in order of popularity)
|45||Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.|
|42||Charges exceed our fee schedule or maximum allowable amount.|
|97||Payment adjusted because the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.|
|22||Payment adjusted because this care may be covered by another payer per coordination of benefits.|
|104||Managed care withholding.|
|24||Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.|
|144||Incentive adjustment, e.g. preferred product/service.|
How Do CARC Codes Get Into Partner?
CARC values enter Partner in two ways.
Autoposting Your ERAs Imports the CARC to Partner
The Auto-Posting Program (autopip), receives and records CARC values on ERAs. When you post insurance payments using autopip, Partner keeps track of the CARC codes indicated by the carrier, if any, along with the amount and group codes which are needed for secondary submission.
In fact, you can use the set of CARC codes to configure what types of charges should be autoposted and which should drop to the manual report for your review and attention.
Contact PCC Support for help setting up autopip.
You Can Enter CARC While Posting Payments
You will see CARC values on your EOBs from most carriers. You can enter CARC values into the manual Post Insurance Payments (pip) program.
For each charge, you can enter a CARC amount, code, and group code. If you only wish to enter the CARC codes, you can press F7 – Hide CARC Fields to switch to a simpler view.
Configure CARC in pip: CARC support in Partner may be deactivated at your practice. You can turn it on in the Charges and Payments section of the Configuration Editor (
ced). You can also select whether one or three CARC fields appear. Contact PCC Support for assistance.
Do Not Post Other Carrier Codes: If your insurance carrier uses a non-CARC system of coded messages, do not post them in the CARC column. CARC values are a national standard and do not match up with Georgia Medicaid message codes or other carrier codes. Instead, some Partner users use payment and adjustment types to indicate messages from carriers.
Where Can I Review CARC Values in Partner?
Once CARC values are entered with payments, where can you find them and how can they benefit your day-to-day work?
CARC Appears in Correct Mistakes (oops)
In the Correct Mistakes (
oops) program, CARC codes appear in line with insurance payment information.
Press F7 – View Adj Reasons and enter an item number to read a description of the codes.
CARC in the Account History Report (tater)
CARC values also appear in the Account History Report (
tater). You can run the Account History in the Family Editor (fame).
CARC Values Appear on Personal Bills
Partner’s personal bills, whether printed in your office or through a remote ebills service, include CARC values and an explanation of what they mean.
You can review the text of any personal bill and see the adjustment reasons in the Correct Mistakes (
Report on the CARC Values Used By Payers
Partner can create reports based on CARCs and amounts. You can create custom CARC reports or use two predefined SRS reports: The “CARC Insurance Detail Report” and the “CARC Summary Report”.
To view a CARC-based report, run
srs and visit the Billing and Collection Reports section.
When you run a report you will be prompted for a date range, and you can add additional criteria to customize the report. The results will display CARC information and help you understand trends in payer responses to your practice.
If you would like help creating a custom SRS report that includes CARC information, or other Partner billing data, contact your Client Advocate.