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 CARCCheck 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. CriteriaUse Criteria to build the details of the rule.
  2. Rule NoteAdd 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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