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

MLN Matters Number: MM11321
Related CR Release Date: June 7, 2019
Related CR Transmittal Number: R4317CP
Related Change Request (CR) Number: 11321
Effective Date: October 1, 2019
Implementation Date: October 7, 2019

CR11321 instructs MACs and 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 Code (CARC), Remittance Advice Remark Code (RARC), and Claim Adjustment Group Code (CAGC) rule publication. These system updates are based on the CORE Code Combination List, which will be published on or about June 4, 2019. Make sure that your billing staffs are aware of these updates.

The Department of Health and Human Services (HHS) adopted the Phase III Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (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.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11321.

Last Updated Jun 11, 2019