Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of CARC, RARC and CAGC Rule - Update from CAQH CORE

MLN Matters Number: MM11039
Related CR Release Date: November 16, 2018
Related CR Transmittal Number: R4168CP
Related Change Request (CR) Number: 11039
Effective Date: April 1, 2019
Implementation Date: April 1, 2019

The Department of Health and Human Services (DHHS) adopted the Phase III (Council for Affordable Quality Healthcare (CAQH) CORE, Electronic Funds Transfer (EFT), and Electronic Remittance Advice (ERA) Operating Rule Set that was implemented on January 1, 2014, under the Affordable Care Act (ACA).

CR 11039 instructs MACs and Medicare’s Shared System Maintainers (SSMs) to update systems based on the Committee on Operating Rules for Information Exchange (CORE) 360 Uniform use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) rule publications. These system updates are based on the CORE Code Combination List to be published on or about February 1, 2019. Make sure that your billing staffs are aware of these changes.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11039.

Last Updated Nov 20, 2018