CARC Management Denial Rules

CARC Management Denial Rules


CARC Management Denial Rules


Modify a Default CARC Denial Rule


There are limited changes that you can make to a System Delivered Rule, but a New Rule can be added to the CARC to define Exceptions.


Libraries > CARC Management


  1. Select the CARC Edit icon.

  1. Select a Category or Add a Category by selecting Manage from the dropdown.
  2. Enter an Effective Date and/or Expiration Date if applicable.

  1. Denial: Check to identify this CARC code as a Denial.
  2. Preventable: Check to identify the Denial as being preventable prior to billing.
  3. Primary CARC: Check to report this CARC as a Primary Denial code.
  • A Non-Primary CARC will be considered Primary when it is the only CARC being adjudicated.
  • If there are multiple Non-Primary CARCs, the CARC with the highest adjudication will be reported as Primary.
  1. Report as RARC: If CARC is generic without denial specifics, a RARC can be used in its place for reporting purposes.
  • This is a conditional denial.
  • If the CARC and the RARC that is entered here are on the remit, the RARC will be reported as a denial.
  • If the CARC is on the Remit but the RARC is not, it will not be reported as a denial.
  1. Add a New Rule to define exceptions to this CARC rule.
  • Once checked, the Reporting RARC field will open to select the RARC.
  1. Select Save [F2].

Add a Category


  1. Select the Edit icon on a CARC.

  1. From the Category dropdown, select Manage.

  1. To Add a Category, select the Add button.
  2. Enter a short Code that is relevant to the Description.
  3. Enter a Description.
  4. Select Save [F2].




Add a New Rule to an Existing CARC

  1. Select the CARC where the New Rule is to be added.

  1. Select the New Rule link.

  1. Rules Info Panel: Complete the fields that are applicable.
  2. Processed As: Select the items to which this rule applies. Use the Check/Uncheck All link to select or deselect all items.
  • Example: For the rule to apply only to Payments that are processed as Primary, select Primary and Primary Forwarded.
  1. Criteria: Use Criteria to build the details of the rule.
  2. Rule Note: Add additional information associated with this rule.
  3. Select Save [F2].


Learn More

CARC Management and Denial Analysis Overview


Denial Analysis Reporting


Denial Analysis: Preventable/Non-preventable Denials



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