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
- Select the CARC Edit icon.
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn61b79f83accea7f30acb86de31d184e57f163a5d1253c9dd6109266c6cf6a94a3fbbadefdf2a7d806eea9a25494b7131?inline=true)
- Select a Category or Add a Category by selecting Manage from the dropdown.
- Enter an Effective Date and/or Expiration Date if applicable.
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn3ad15501c8c07472ab0db17bfe6140ee9312f1770eb2c55360b9ecbf87b6ba884c8e84485b7888e15fa9426aa9117727?inline=true)
- Denial: Check to identify this CARC code as a Denial.
- Preventable: Check to identify the Denial as being preventable prior to billing.
- 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.
- 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.
- Add a New Rule to define exceptions to this CARC rule.
- Once checked, the Reporting RARC field will open to select the RARC.
- Select Save [F2].
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn04e2c8b3fc6a10c42489c2f0f5befaf194ca89b16c5774b622fd970ad43830d51493ead092b82579728208d6c6788db6?inline=true)
Add a Category
- Select the Edit icon on a CARC.
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn3f2207d2260309cd15bf11902ef8f47d08ff9eed47d98ada7e59ebf64e5980b210e79c2999034dae77d986e648371daf?inline=true)
- From the Category dropdown, select Manage.
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn04e2c8b3fc6a10c42489c2f0f5befaf1edb62e3ea69f87f064be3d504eebc9e169ee004a05850c5117439b26fa65cb8a?inline=true)
- To Add a Category, select the Add button.
- Enter a short Code that is relevant to the Description.
- Enter a Description.
- Select Save [F2].
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn053ff3e902800a48c308a5045dfbc85ae241fcfc8d0f5c00bdc007e8645ea9f07a1e999cfa4496f80c050c1c3c7a4ba9?inline=true)
Add a New Rule to an Existing CARC
- Select the CARC where the New Rule is to be added.
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn3f2207d2260309cd15bf11902ef8f47d1a3d345a13df2c00180301ad8a23729d55f3e362760ccacc7380baf59582348d?inline=true)
- Select the New Rule link.
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn99c71dfe26ce0c7c7519f79da0722ea3befb9e6962ead899b2f85850273de587d52a39d76d27b716d13b3697e83a527f?inline=true)
- Rules Info Panel: Complete the fields that are applicable.
- 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.
- Criteria: Use Criteria to build the details of the rule.
- Rule Note: Add additional information associated with this rule.
- Select Save [F2].
![](https://support.pmhelpcenter.com/galleryDocuments/edbsn3ad15501c8c07472ab0db17bfe6140ee8edd3ce8db9da91c3ace8a9253388b38dbdd90862f19883cc1b6ffe40a34d74c?inline=true)
Learn More
CARC Management and Denial Analysis Overview
Denial Analysis Reporting
Denial Analysis: Preventable/Non-preventable Denials