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Back  RFI # 2319: When to use CARC 45 vs. CARC 1

Formal vs. Informal Help Informal Formal


Joshua Mier


When would it be appropriate to use CARC 45 vs. CARC 131 when paying a claim? If charges are discounted in accordance with a contract between the payer and the provider, is CARC 45 or CARC 131 more appropriate. What if charges are discounted according to a Discount Rate agreement such as shared savings, which CARC between CARC 131 or CARC 45 be the correct CARC to use? Please clarify what the difference is between paying a claim at the contracted rate (CARC 45) vs. paying a claim specific negotiated discount (CARC 131).


Could you please send this back to the submitter and let them know RFIs are not used for interpretting the TR2s. Please ask them to send their questions about CARCs to codes-help@x12.org.

Submission 9/13/2018
Status Date 10/5/2018
Status F - Final
Primary References
Document CARC