Issue Corrected: CARC 94 Appropriately Reporting on Remittance Advice (RA) and 835, TR 63097

Maine Department of Health & Human Services sent this bulletin at 04/07/2017 01:42 PM EDT

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Issue Corrected: CARC 94 Appropriately Reporting on Remittance Advice (RA) and 835, TR 63097

When the amount MaineCare pays on a claim exceeds the billed charges, the portion of the paid amount that exceeds the billed charges should be reported on an RA or 835 with CARC 94 (Processed in excess of charges). CARC 45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement) was reported on the RAs and 835s in place of CARC 94 in error. This issue has been corrected and CARC 94 should report on RAs and 835s as appropriate.

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