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Back  RFI # 1748: Eff/Term Dates of CARC RARC

Formal vs. Informal Help Informal Formal

Submitter

Brian Wagner

Description

Are the Effective and Termination dates of CARC and RARC codes used in 835's tied to the file creation date, or the Date of Service for the claim line to which the CARC/RARC code applies?

Please consider the following example. A claim line has a Date of Service of 5/1/12, but the claim wasn't transmitted in an 835 until 6/14/12 and that claim line included CARC 242 which became effective on 6/3/12. Is the use of CARC 242 compliant in this case because the 835 was created after 6/3/12?

Submitter Assigned Keywords

835 CARC RARC Effective Termation Dates

Response

Since the CARC and RARC code lists are external to the 835, how and when they can be used is the purvue of the groups that own the code lists, and/or the Department of Health and Human Services. In the HIPAA regulations, the CARC and RARC code lists are considered to be non-medical code lists, which means that the date of the transaction determines code validity. For the CARC list, the owning committee has an FAQ related to this topic that states:

"Stop
When populated, this date identifies that the code can no longer be used in original business messages after that date. The code can only be used in derivative business messages (messages where the code is being reported from the original business message). For example, a Claim Adjustment Reason Code with a Stop date of 02/01/2007 would not be able to be used by a health plan in a CAS segment in a claim payment/remittance advice transaction (835) dated after 02/01/2007 as part of an original claim adjudication (CLP02 values like "1", "2", "3" or "19"). The code would still be able to be used after 02/01/2007 in derivative transactions, as long as the original usage was prior to 02/01/2007. Derivative transactions include: secondary or tertiary claims (837) from the provider or health plan to a secondary or tertiary health plan, an 835 from the original health plan to the provider as a reversal of the original adjudication (CLP02 value "22"). The deactivated code is usable in these derivative transactions because they are reporting on the valid usage (pre-deactivation) of the code in a previously generated 835 transaction."
Submission 2/7/2013
Status Date 3/29/2013
Status F - Final
Primary References
Document 005010X221
Section2.4
Page198
Set ID835
Table2
Loop2110
Segment Position0900
Segment IDCAS
Element Position2
Industry NameAdjustment Reason Code
External Code List139
Code Value242