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Back  RFI # 694: One CARC w/ Multiple Grp codes

Formal vs. Informal Help Informal Formal

Submitter

Meg Barber

Description

HIR # 213's response states "We can't think of a business scenario where the same code (CARC) would be used with two different group codes as a valid business situation." The NY state health care surcharge, reported with CARC 137, has both a payer and patient portion.
As such, there is a need with this surcharge at times to report CARC 137 with multiple Group Codes in the same claim. In fact, under different scenarios, one claim in the 835 can need CARC 137 with Group Codes CO, PR and OA. Please validate that this usage is in fact a business situation that does require usage of CARC 137 with different Group Codes in the same 835 claim.

Submitter Assigned Keywords

835 137

Response

The described situation related to CARC 137 does represent a business situation where the same CARC must be used with different Claim Adjustment Group Codes in the same claim. As such, it is valid in this case for a specific 835 claim to send the same CARC in multiple CAS segments with different group codes.
Submission 10/2/2008
Status Date 1/8/2009
Status F - Final
Primary References
Document 004010x091a1
Section2.2.4
Page24
Set ID835
Table2
Loop2100
Segment IDCAS
Code Value137