CARC

A Claim Adjustment Reason Code (CARC) is a standardized code published by Washington Publishing Company (WPC) and adopted by CMS that explains why a payer paid a claim at a different amount than billed, or denied it entirely. CARCs appear on the Electronic Remittance Advice (ERA/835) and on paper EOBs. The group prefix (CO = Contractual Obligation, OA = Other Adjustment, PR = Patient Responsibility) determines who is financially responsible. AppealWin covers the 15 most common behavioral health CARC codes.