📚 Documentation
Everything you need to know about medical denial codes
Getting Started
Medical denial codes are standardized codes used in healthcare billing to communicate the reasons for claim adjustments, denials, or additional information requirements.
🎯 What Are CARC Codes?
Claim Adjustment Reason Codes (CARC) are nationally standardized codes maintained by X12. They explain why a claim or service was paid differently than billed.
- Published and maintained by the Washington Publishing Company
- Required for HIPAA-compliant electronic remittance advice (ERA)
- Used on both paper and electronic EOBs
- ~300 active codes covering all adjustment scenarios
💬 What Are RARC Codes?
Remittance Advice Remark Codes (RARC) provide additional explanation and information to supplement CARC codes.
- Offer more detailed context about claim processing
- Can indicate missing information or documentation
- Alert providers to potential issues or requirements
- Often paired with specific CARC codes
How to Use This Site
Identify the Code
Find the CARC or RARC code on your EOB or ERA. Codes are typically numeric (CARC) or alphanumeric (RARC).
Search or Browse
Use the search bar or browse by category to find your specific code.
Review the Guide
Each code page includes: official definition, plain English explanation, common causes, step-by-step solutions, and prevention tips.
Take Action
Follow the resolution steps, gather required documentation, and resubmit or appeal as appropriate.
Understanding Code Categories
Patient Responsibility
Deductibles, coinsurance, copayments, and other patient financial obligations.
Coding Errors
Issues with procedure codes, modifiers, diagnosis codes, or code combinations.
Authorization
Missing, invalid, or expired prior authorizations and referrals.
Eligibility
Coverage issues, including terminated benefits and dependent verification.
Medical Necessity
Services deemed not medically necessary or experimental.
Timely Filing
Claims submitted after payer-specific filing deadlines.
Best Practices
- ✅ Always verify patient eligibility before service
- ✅ Obtain necessary authorizations in advance
- ✅ Code to the highest level of specificity
- ✅ Document medical necessity thoroughly
- ✅ Submit claims within filing limits
- ✅ Review denial patterns regularly
- ✅ Appeal inappropriate denials promptly
- ✅ Keep detailed records of all communications