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Denials, Appeals & AR
Revenue cycle · Intermediate · 1 lessons
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Reading CARC and RARC codes
12 min read
Claim adjustment reason codes explain every dollar that did not pay. Pair the group code (CO/PR/OA/PI) with the CARC and any RARC to decide whether to write off, correct, appeal or bill the patient.
- ✓CO-45 exceeds fee schedule — contractual, write off.
- ✓CO-97 payment included in another service — check bundling and modifier eligibility.
- ✓CO-16 missing information — read the RARC to learn exactly what is missing.
- ✓PR-1/2/3 deductible, coinsurance, copay — bill the patient.
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Flashcards
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Case studies
Apply the guidelines to real documentation
Timely filing appeal
A $1,150 claim denies CO-29. Your clearinghouse report shows the claim was accepted by the payer 22 days after the date of service.
Best action?
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Knowledge check
2 questions
1. CO-97 most likely requires:
2. CO-29 means:
Verify all coding decisions against current official guidelines.