SoonerCare claim adjustment changes coming

Posted on: 4/4/18


Hospitals and other Oklahoma Medicaid providers should soon find it easier to understand and process SoonerCare claim denial and adjustment reasons.

After April 7, electronic remittance advice (835) files for SoonerCare payments will include additional claim adjustment reason codes (CARCs) and/or remittance advice remark codes (RARCs). Prior to this change, SoonerCare 835 files included only a single CARC for an adjustment or denial, and it was often not specific about the reason for the claim adjustment.  

A workgroup created by OHA with representatives from the Oklahoma Health Care Authority (OHCA), Mercy, INTEGRIS, and SSM/St. Anthony agreed last year on a number of changes in the CARCs reported for common SoonerCare adjustments. But OHCA’s 835 files reported only one CARC, and it was usually a generic code that provided no information about the actual reason for the adjustment.  

To report multiple CARCs, OHCA will begin splitting the dollar amount of the adjustment into approximately equal amounts for each CARC, to a maximum of six. This change will be effective with payments made after April 7, 2018.

These electronic remittance advice changes will give providers more specific information needed to process adjustments or correct claims, reducing research and phone calls to OHCA. OHCA will consider making further revisions to the CARCs and RARCs they use, if appropriate. (Rick Snyder)

Save the dates for OHA 2022 events

Posted on: 2/18/22


It’s a new year and a new lineup of important events for you and your staff. Don’t miss out on these opportunities to engage in advocacy, education and networking all year long. Mark your calendar now!

OHA Advocacy Day - Tuesday, April 5, Oklahoma History Center. Join us for our annual legislative day. We will begin with a member briefing at 3 p.m., followed by a legislative reception at 5 p.m. Watch for registration materials soon.

OHA-PAC Golf Tournament - Tuesday, June 21, Jimmie Austin Golf Club at OU, Norman. Time and details TBA.

OHA Health Care Leaders Forum - Tuesday, July 19 - Thursday, July 21, Shangri-La Resort, Grand Lake. Watch for registration soon!

OHA Connect 22 - Wednesday, Nov. 9 - Friday, Nov. 11, Oklahoma City Convention Center and Omni Hotel, downtown Oklahoma City. Plan now to attend OHA’s annual conference and exhibit hall. More details to come.

Details on these events and other upcoming education opportunities will be available on the OHA website.