Attention: Providers Prior Payer CARC 97 EOB 01843 Update

UPDATE: This is a follow up to the September 25, 2017 announcement  regarding the temporary change related to CARC 97 reported on claims by the prior payer.

Note:  CARC 97 description: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

Beginning January 8, 2018, NCTracks, based on the direction of the North Carolina Division of Medical Assistance, will resume posting Explanation of Benefits (EOB) 01843 - MEDICAID DENIED BASED ON CLAIM ADJUSTMENT REASON ASSIGNED BY PRIOR PAYER when the claim is submitted with prior payer CARC 97 reported at the claim header or detail line. The only exception will occur when a prior payer reports CARC 97 on the claim line with an Allowed Amount greater than zero.

Important Instruction: Prior payer Claim Adjustment Group Code (CAGC) and CARC information must be submitted to NCTracks, either by X12 batch transaction or via Provider portal, exactly as it appears on the prior payer EOB/Remittance. This includes accurately submitting codes at the header or detail claim line.

Guides and additional information: Providers submitting claims with prior payer details on the Provider Portal are encouraged to review the document on 'How to Indicate Other Payer Details on a Claim In NCTracks and Batch Submission' under 'Claims' on the Provider User Guides and Training page. This guide provides instruction for entering prior payer information such as CARCs, CAGCs and the adjustment amounts.

Providers with questions can contact the CSRA Call Center at 1-800-688-6696 (phone), 1-855-710-1965 (fax) or (email).