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Provider Remittance Advice

 
The Utah Health Information Network (UHIN) has requested all payers report Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC), and associated Group Codes (GC) for each claim billed.
The CARC’s & RARC’s allow providers to more easily bill eCOB for secondary claims.
Additional fields added to make the remittance advice easier to read and understand.

CARC’s, RARC’s, & Group Codes
These codes sets are a national standard, and are maintained by the Health Care Code Maintenance Committee.  For more information visit www.wpc-edi.com

The CARC, RARC, and GC code sets were created for use with the Electronic Claim Remittance Advice (835 transaction) to explain why an ‘Adjustment’ was made to a claim line.

An ‘Adjustment’ is any amount that is not considered for payment (contractual obligations, deductible, coinsurance, copay, other carrier payments, denied services, etc…)

Improved Summary and Recovery Section
Simplified Line, Claim, and Payment Summary Balancing.

“Forward Balance” information added for claims that were not fully recovered on the remittance advice.
All Corrections and Reversals made on the current payment will appear in the Recovery Section with Recovery and/or Forward Balance detail.

For more information on the new Remittance Advice please click here
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