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Printed Date: 9/22/2015
CARCs and RARCs are codes used on the Medicare provider remittance advice (RA) to explain any adjustment(s) made to the payment.
CARCs, or Claim Adjustment Reason Codes, explain financial adjustments, such as denials, reductions or increases in payment. CARCs explain why a claim (or service line) was paid differently than it was billed. CARCs are used in the RA with group codes that shows the liability for amounts not covered by Medicare for a claim or service. Group codes include CO (contractual obligations), OA (other adjustments) and PR (patient responsibility). CARCs can be reported at the service-line level or the claim level.
RARCs, or Remittance Advice Remark Codes, are used in the RA in conjunction with CARCs to further explain an adjustment or relay informational messages that cannot be expressed with a claim adjustment reason code. Most RARCs are supplemental and further explain an adjustment already described by a CARC. Other remark codes are informational and do not further explain a specific adjustment but provide general adjudication information. Informational remark codes start with the word "Alert." RARCs can be reported at the service-line level or the claim level.
Resource: IOM 100-04, Medicare Claims Processing Manual, Chapter 22, Section 60 (PDF, 112 KB).
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Last Updated: 09/01/2020