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

MLN Matters Number: MM11394
Related CR Release Date: August 23, 2019
Related CR Transmittal Number: R4376CP
Related Change Request (CR) Number: 11394
Effective Date: January 1, 2020
Implementation Date: January 6, 2020

CR 11394 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 publication. These system updates are based on the CORE Code Combination List to be published on or about October 1, 2019. Make sure that your billing staffs are aware of these changes.

The Secretary of Health and Human Services (HHS) 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.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11394.

Last Updated Aug 26, 2019