Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List.

What is the Remittance Advice Remark Code Committee?

The Remittance Advice Remark Code Committee is the group that maintains the Remittance Advice Remark Code list.

Who are the members of the Remittance Advice Remark Code Committee?

The Remittance Advice Remark Code Committee members represent various components from CMS.

Is this a Medicare list?

The Remittance Advice Remark Codes began as a proprietary list created and supported for Medicare use. However, when the list was named in the HIPAA Rules, it ceased being Medicare specific and became an industry standard list that supports all implementers.

What does the acronym RARC stand for?

Remittance Advice Remark Code.

What does the acronym CARC stand for?

Claim Adjustment Reason Code.

Where are the RARCs used?

The RARC are used in electronic remittance advices, as mandated under HIPAA, or in paper remittance advices. In electronic transmissions, RARC are transmitted in the 835 transaction at either the claim or service line level as appropriate for the specific situation. RARC may be transmitted in the following data elements; MIA05, MIA20, MIA21, MIA22, MIA 23, MOA03, MOA04, MOA05, MOA06, MOA07 and LQ02. RARCs at the claim level convey information about claim level adjustments or about the overall processing of the claim. RARCs at the line level convey information about adjustments for the specific service line or about the processing of those services.

How is a RARC used?

Each RARC is paired with a specific message. A trading partner, usually a payer, transmits a RARC to another entity, usually a provider. The receiving entity uses the message associated with the RARC to understand the sending entity’s communication.

What is the difference between RARC and CARC?

CARC explain an adjustment (an amount paid which is different than the amount billed, including a zero payment or a denial) to the amount submitted by the provider. RARC accomplish two purposes. They convey informational messages about general remittance practices or they provide supplemental explanation for an adjustment already described by a CARC.

What is the relationship between RARCs and CARCs?

Since RARCs provide information about remittance processing or further explain an adjustment, they are rarely used unless there is an adjustment to report and the CARC is insufficient explanation of the adjustment when it stands alone or the sender needs to provide specific information about the remittance advice itself.

I don’t understand how CARCs and RARCs work together.

An example of the two codes working together is a remittance advice which includes CARC 148, which says “Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete” and RARC M29 which says “Missing/incomplete/invalid operative report”. The two codes together convey that information is missing and that the missing information is a report from a surgeon.

How do I request a new RARC?

There are just a few steps to follow:
  • Review the existing RARC and RARC lists to verify that a code doesn’t already exist that meets your business need.

    These code lists are available from the Washington Publishing website, http://www.wpc-edi.com/reference/.
  • If you don’t find a RARC or CARC that meets your business need, use the request form to enter a request for a new code. Be sure to provide all the requested information, including a detailed business justification explaining why the RARC is needed.

    The request form is found at http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/

How do I request a change to the text of an existing RARC?

Use the request form to identify the RARC you are recommending be revised and the revised text. Be sure to provide all the requested information, including a detailed business justification explaining why the RARC is needed.
The request form is found at http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/

What is a business justification?

A business justification explains the scenario in which the requested RARC would be sent in an 835 or paper remittance document. A well-defined justification will facilitate the committee’s understanding of the request.

An appropriate business justification would be “a new code with this text would be sent to let a submitter know that the patient listed on the claim is not a member of our health plan.” “Because we need it” and “We currently send this message and want to have a code for it” would not be appropriate business justifications.

Once I have submitted a request, how do I monitor it?

Active requests can be viewed in the RARC Online Conference, which is available to any interested party at http://webboard.wpc-edi.com/~remittance. Interested parties may also comment on active requests or posted decisions using the features of the Online Conference.

What is the maintenance process?

Each request follows this process:
    A maintenance request is submitted via the request form. The request is then viewable in the RARC Online Conference, which is available to any interested party at http://webboard.wpc-edi.com/~remittance. The RARC Committee evaluates the request, makes a determination, notifies the requester of the committee's decision and posts the decision in the RARC Online Conference. The submitter, or any other interested party, may comment on the decision using the features of the online conference. The RARC Committee publishes a new version of the RARC List. The list is published tri-annually in March, July, and November.

What evaluation criteria does the RARC Committee use?

Each request is evaluated against the following criteria:
    Can the business requirement be met with an existing RARC or CARC code? Does the text of the requested message support compliant electronic claims and remittance advices? Is the text of the requested message generic enough for general use by multiple payers, for multiple benefit plans, or in multiple situations? Is this specific language required explicitly by Federal or State regulations? Is the text of the requested message communicated in simple components for maximum industry use?

Why was my request for a very specific request denied?

The RARCs began as a proprietary list created and supported for Medicare use only. The text of those original codes can be very specific. Once the list was named in the HIPAA Rules as an industry standard, the decision was made that the text of all new codes would be generic enough for general use by multiple payers, for multiple benefit plans, or in multiple situations. RARCs related to specific procedures, specific time requirements or specific data elements are severely restricted. All new requests are evaluated against this criterion.

I have two points to make in the text of my requested message.

The text of all new RARCs must be broken down into their simplest components for maximum industry use. Multiple RARCs may be transmitted to communicate explicit messages. All new requests are evaluated against this criterion.

Will a RARC be approved for use with a non-compliant 837?

The text of all new RARCs must support compliant electronic claims. All new requests are evaluated against this criterion.

Can RARCs be used to explain why a claim was not accepted?

This is not a supported business use of the 835 transaction. It is expected that non-compliant claims will be identified in a front-end process or in an application process and reported in an appropriate response transaction rather than in the 835 remittance advice. All new requests are evaluated against this criterion.

When can I begin to use a new approved RARC?

You can begin to use the new RARC when a new version of the RARC List is published, unless the code was approved with a specific start date. The exact effective date will be identified as the Start date in the RARC list. New versions of the list are published in March, July and November.

When is a deactivated RARC no longer permissible?

A deactivation is effective 6 months from the publication date of the version of the list that identifies the RARC as deactivated. The exact deactivation date will be identified as the Stop date in the RARC list. New versions of the list are published in March, July and November.

When can I begin to use the new text for a modified RARC?

You can begin to use the new text when a new version of the RARC List is published, unless the revision was approved with a specific start date. New versions of the list are published in March, July and November.

When is the RARC List updated?

The RARC List is updated tri-annually in March, July, and November.

What is an effective, or start, date?

The date a RARC may first be used in a remittance transaction.

What is a deactivation, or stop, date?

When populated, this identifies the first date that the RARC can no longer be used in original transmissions.

A deactivated RARC may still be used in derivative transmissions (transmissions reporting on activity when the code was valid). The deactivated code is usable in these derivative transactions because they are reporting on a valid usage (pre-deactivation) of the code in a previously generated 835 transaction.

For example, a RARC with a Stop date of 02/01/2007 cannot be used by a health plan 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 may 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, and an 835 from the original health plan to the provider as a reversal of the original adjudication (CLP02 value "22").

What is the Last Modified date?

When a message has been revised after publication, this is the date that the message was last modified by the committee.

Once the text of a RARC is approved, is it static?

Not necessarily, there are two ways that an existing RARC can be modified. One way is that someone can submit a recommendation for a change in the wording via the RARC maintenance process. The other way is through periodic reviews undertaken by the RARC Committee. These reviews are intended to improve consistency and reduce inadvertent duplicate messages.

Can RARCs be used at both the claim level and the service line level?

Any RARC can be used at either the claim or service line level as appropriate. RARCs at the claim level usually convey information about claim level adjustments or about the overall processing of the claim. RARCs at the line level convey information about adjustments for the specific services identified in that service line or about the processing of those services. A RARC might appear at the claim level if there are no claim level adjustments in order to communicate information about the processing of the claim that applies to all service lines and adjustments to service lines.