CARC Management & Denial Analysis Overview

CARC Management & Denial Analysis Overview


CARC Management and Denial Analysis Overview


CARC Management & Denial Analysis Reporting

CARC Management and Denial Analysis provides the ability for Clients to identify, categorize, and manage their CARC codes and report on Denials.

  • Using CARC Management, meaning denials can be identified and categorized.
  • Libraries > Claim Tables Panel > CARC Management button
  • The Denial Analysis Report provides high level reporting based on the CARC setup.
  • Reports > A/R Panel > Denial Analysis button.



CARC Management Denial Rules on Specific CARC Codes  

A Default Denial Rule is System delivered for every CARC Code.


CARC Management Denial Rule Logic

  • Category: Categorize CARC Codes for reporting purposes.
  • Denial: Identifies the CARC code as a Denial.
  • Preventable: Allows you to Identify a Denial that could have been prevented prior to billing.
  • Primary CARC: A Non-Primary CARC is a Primary Denial when it is the ONLY CARC used for Adjudication. If there are multiple Primary CARCs, the one with the highest adjudication priority will be Primary.
  • Use RARC: If the CARC is generic, this will allow the User to report a RARC code in place of the CARC code

Denial Analysis Report

  • Reports on CARC codes that are designated as Denials.
  • Denial Rate: Percentage (%) breakdown by ANSI CARC Codes
  • Denial resolution rate: Percentage (%) of Denied Claims that are subsequently processed and paid (By user, By code, By Facility).
  • Calculation: Claims paid that have codes designated as Denial codes divided by the total number of Denials in a given period.
  • Option to report only Top Denials.
  • Encounter Completed by: Filter by the User who last completed the Encounter.
  • Denial Date: Determined by Posted or Not Posted.
  • If the Denial is posted, the Denial Date is the Posted Date.
  • If the Denial is not posted, the Denial Date is the ERA Loaded Date.
  • If the Posted CARC code does not match the CARC Code on the Remit, the Denial Date will be the ERA Loaded Date.
  • If you choose to include the Not Posted Denials on the report for the month of May, all Not Posted Denials with an ERA Loaded Date in May will be on the report.
  • The results of the Denial Analysis can be sent to a Charge Worklist.
  • Group By/Subgroup By options.
  • Displays key statistics on output: Percentage of Denials, Number of Denials, and Percent of Claims Denied.
  • Display Key for Preventable (PV) denials and Primary (P).

Learn More





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