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Back  RFI # 1056: Multiple Denial Reasons

Formal vs. Informal Help Informal Formal

Submitter

Dora Lambert

Description

Is there a way to report multiple claim denial reasons (CARC's) for the billed charge amount? Is it possible to split the dollar amount across the claim by the number of denial reasons? If so, how would the provider handle this in their account receivable? Reporting only one CARC per claim (or claim line) prevents the provider from being able to correct all applicable denial or reject reasons prior to resubmission.

Submitter Assigned Keywords

CARC

Response

There is no way in the 5010 835 to report and/or associate multiple adjustment reason codes with a single dollar amount.
As a result of structural changes to the 835 standard, the developers plan to correct this situation in the next version of the guide.
Submission 5/21/2010
Status Date 9/20/2010
Status F - Final
Primary References
Document 005010X221
Section1.10.2.4
Page21
Set ID835