Section title: Requests for Interpretation
RFI #
1748
Eff/Term Dates of CARC RARC
Description

Are the Effective and Termination dates of CARC and RARC codes used in 835's tied to the file creation date, or the Date of Service for the claim line to which the CARC/RARC code applies?

Please consider the following example. A claim line has a Date of Service of 5/1/12, but the claim wasn't transmitted in an 835 until 6/14/12 and that claim line included CARC 242 which became effective on 6/3/12. Is the use of CARC 242 compliant in this case because the 835 was created after 6/3/12?

RFI Response

Are the Effective and Termination dates of CARC and RARC codes used in 835's tied to the file creation date, or the Date of Service for the claim line to which the CARC/RARC code applies?

Please consider the following example. A claim line has a Date of Service of 5/1/12, but the claim wasn't transmitted in an 835 until 6/14/12 and that claim line included CARC 242 which became effective on 6/3/12. Is the use of CARC 242 compliant in this case because the 835 was created after 6/3/12?

DOCUMENT ID
005010X221 - on hold for Triage review due to policy and external aspects.