SoonerCare claim adjustment codes improving

Posted on: 11/29/17

SoonerCare providers now receive a better explanation of claim adjustments and denials, starting last week.

The Oklahoma Health Care Authority (OHCA) has revised 38 of its most common claim adjustment reason codes (CARCs) and/or remittance advice remark codes (RARCs) reported on electronic remittance advices to providers. These changes will give providers more specific information needed to post adjustments or correct claims, reducing research and phone calls to OHCA.  

For example, when the service date reported on a claim is not during a SoonerCare member’s eligibility period, OHCA has reported CARC 96, “Non-covered charge(s).” Instead, CARC 239 will be reported in the future: “Claim spans eligible and ineligible periods of coverage. Rebill separate claims.”

OHCA will soon begin reporting more than one CARC, when applicable. Testing is underway on programming changes to split claim adjustments among multiple CARCs when appropriate.

After these changes are implemented, OHCA will collaborate with OHA on further improvements in its reporting of claim adjustment reason codes and remark codes. (Rick Snyder)

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