Interpreting ERAs & EOBs

Question 1

What are Reason Codes?

Answer 1

These standardized codes are used to describe how a claim was adjudicated and paid.

Question 2

What is a CARC?

Answer 2

Claim Adjustment Reason Code

Question 3

What are RARCs?

Answer 3

Remittance Advice Remark Code

Question 4

What are Group Codes?

Answer 4

A code identifying the general category of payment adjustment.

Question 5

What is CO?

Answer 5

Contractual Obligation, this group code is used when an in-network provider bills more than the allowed amount, and the difference is indicated as adjustment or write-off.

Question 6

Are adjustments/write-offs patient’s responsibility?

Answer 6

No, you cannot bill a patient the adjusted amount, it’s called balance-billing.

Question 7

What is PR?

Answer 7

Patient Responsibility, this group code is used when the adjustment represents an amount that is the patient responsibility. I.E. Deductible, Copay, Coinsurance

Question 8

What is OA?

Answer 8

Other Adjustment, this group code is used when no other group code applies to the adjustment.

Question 9

How many Reason Codes are used with Group Codes?

Answer 9

400