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Back  RFI # 691: 835 Duplicate CARC GR w/in seg

Formal vs. Informal Help Informal Formal

Submitter

Meg Barber

Description

As a result of NY state regulations, there is a need for providers to receive state surcharge information in the CAS segment using CARC 137. In order to provide the needed information, sometimes two CAS trios are needed with the same 137 reason code to identify health plan or patient surcharge amount (to the provider) and an offsetting entry identifying that the health plan is taking that money back and paying it directly to the state. The net 137 adjustment is then $0. Please validate that in this specific situation it is valid to use a CAS segment with two uses of that same CARC - specifically CARC 137 when the net is $0.

Submitter Assigned Keywords

835 Duplicate CARC usage w/in a segment code 137 NYS Surcharge

Response

While HIR # 171 excluded the possibility of two CAS trios using the same CARC code, this business situation does require this usage. In this case, the trio using a negative dollar amount IS effectively a different adjustment than the one with a positive dollar amount identifying return of the funds to remit to the state. Both are identified by CARC 137 (Regulatory Surcharges, Assessments, Allowances or Health Related Taxes). As such, usage of two CARC 137 trios with the same Group Code where the dollar amounts net to $0 is allowed.
Submission 9/25/2008
Status Date 11/21/2008
Status F - Final
Primary References
Document 004010x091a1
Section2.2.4
Page95
Set ID835
Loop2000
Segment IDCAS
Industry NameClaim Adjustment Reason Code
External Code ListCARC
Code Value137