Explore Code Libraries
Comprehensive databases for every denial scenario
CARC Codes
Claim Adjustment Reason Codes explain why a claim was paid differently than billed.
Browse Library →RARC Codes
Remittance Advice Remark Codes provide necessary context and additional info.
Browse Library →Documentation Guide
Best practices for appeals, resubmissions, and preventing future denials.
Read Guide →Most Common Denials
Quick access to the codes affecting revenue most frequently
| Code | Type | Description | Category | Action |
|---|---|---|---|---|
| 1 | CARC | Deductible Amount | Patient Responsibility | Resolve |
| 2 | CARC | Coinsurance Amount | Patient Responsibility | Resolve |
| 16 | CARC | Claim/Service Lacks Information | Missing Info | Resolve |
| 22 | CARC | Coordination of Benefits | Payer Issue | Resolve |
| N130 | RARC | Consult Plan Benefit Documents | Plan Info | Resolve |
| M15 | RARC | Separately Billed Services | Billing | Resolve |
The Ultimate Guide to Medical Denial Codes
Navigating the complex world of medical billing requires a deep understanding of standard denial codes. Our platform serves as a centralized, authoritative reference for healthcare providers, billing specialists, and revenue cycle managers.
Understanding CARC Codes
Claim Adjustment Reason Codes (CARC) are the primary mechanism used by payers to communicate why a claim was paid differently than billed. Mandated by HIPAA, these codes appear on every Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB). From "Patient Responsibility" adjustments (PR) to "Contractual Obligations" (CO), decoding CARCs is the first step in effective denial management.
- Identify the root cause of payment variances
- Distinguish between billable and non-billable denials
- Streamline the appeals process with accurate data
The Role of RARC Codes
While CARCs explain the "what," Remittance Advice Remark Codes (RARC) explain the "why." These supplemental codes provide critical context—such as missing documentation specifics or coordination of benefit details—that isn't covered by the primary adjustment reason. Successfully resolving a claim often hinges on interpreting the RARC correctly alongside its corresponding CARC.
- Clarify ambiguous claim adjustments
- Pinpoint specific missing information
- Determine if an appeal is viable
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