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.
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- Select a Category or Add a Category by selecting Manage from the dropdown.
- Enter an Effective Date and/or Expiration Date if applicable.
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- 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].
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Add a Category
- Select the Edit icon on a CARC.
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- From the Category dropdown, select Manage.
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- To Add a Category, select the Add button.
- Enter a short Code that is relevant to the Description.
- Enter a Description.
- Select Save [F2].
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Add a New Rule to an Existing CARC
- Select the CARC where the New Rule is to be added.
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- Select the New Rule link.
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- 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].
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Learn More
CARC Management and Denial Analysis Overview
Denial Analysis Reporting
Denial Analysis: Preventable/Non-preventable Denials