Changes to remittance advice (RA) and explanation of benefit (EOB) codes effective the week of Dec. 2

Listening to your feedback is important to us. That's why we've identified additional areas for improvement and made changes in how we're using some claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs).

What are CARCs and RARCs?

CARCs and RARCs are national administrative code sets that communicate a reason for a payment adjustment. It describes why a claim or service paid differently than how it was billed.

New information shared on the paper RA and EOB

The table below reflects the changes effective the week of Dec. 2 for some CARC and RARC reporting for commercial, Medicare and Medicaid claims. These changes will affect the paper remittance advice and member explanation of benefits.

CARC 22 with RARC N197 and the reason code and description

Reason Code Description
O36 Claim will be reconsidered after receipt of member response to investigation letter. See Coordination of Benefits.
OY9 Claim will be reconsidered after receipt of member response to investigation letter. See Coordination of Benefits.
J29 Claim reconsidered when info requested from member is received
J33 Claim reconsidered when info requested from member is received

New information shared on the electronic remits

Electronic remits will only report the new CARC and RARC code. They do not include the reason code or description.

What do I need to do?

Update your system as needed, and if you have any questions, contact provider.services@priorityhealth.com.