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Updated as of April 8, 2025
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| Goodbill Service | When to Apply | Type | Code | Standard Remark | Custom EOB Remark | Accompanying RARC (if applicable) | Standard RARC Remark |
|---|---|---|---|---|---|---|---|
| Claim Review | Edits - Unbundling | CARC | 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. | |||
| Claim Review | Edits - Upcoding | CARC | 150 | Payer deems the information submitted does not support this level of service. | |||
| Claim Review | Edits - Duplicate Charge | CARC | 18 | Exact duplicate claim/service. | |||
| Claim Review | Edits - Incorrect Quantity | CARC | 57 | Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. | |||
| Claim Review | Edits - Incorrect Code | CARC | 65 | Procedure code was incorrect. This payment reflects the correct code. | |||
| Claim Review | Edits - Procedure Not Documented | CARC | B12 | Services not documented in patient's medical records. | |||
| Claim Review | Edits - Medically Unnecessary | CARC | 50 | These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. | N842 | Patient cannot be billed for charges. | |
| 501(r) | Denial upon Application Submitted | CARC | PR22 | This care may be covered by another payer per coordination of benefits. | Claim denied. This plan is secondary to other discounts or coverage that may be available. | ||
| 501(r) | When repricing to AGB | CARC | 96 | Non-covered charges. | Hospital discount applied per your plan benefits; you are not responsible for charges above this amount. | N130, N578, M41, MA02 | Consult plan benefit documents/guidelines for information about restrictions for this service. |
Coverages do not apply to this loss.
We do not pay for this as the patient has no legal obligation to pay for this.
Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 90 days of the date you receive this notice. | | 501(r) | When repricing to AGB | CARC | 45 | Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. | Hospital discount applied per your plan benefits; you are not responsible for charges above this amount. | N130, N578, M41, MA02 | Consult plan benefit documents/guidelines for information about restrictions for this service.
Coverages do not apply to this loss.
We do not pay for this as the patient has no legal obligation to pay for this.
Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice. |