CARC 260: Processed under Medicaid ACA Enhanced Fee Schedule.
Processed under Medicaid ACA Enhanced Fee Schedule.
CARC 260 is the code your insurance company used to explain why your claim was reduced, denied, or paid less than expected. It appears on your Explanation of Benefits (EOB) — the statement your plan sends after a claim is processed. Here's what it means for you and what you can do about it.
What CARC 260 means
The official X12 description is: “Processed under Medicaid ACA Enhanced Fee Schedule.”
In plain language: Processed under Medicaid ACA Enhanced Fee Schedule.
What to do next 260
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 260 group codes explained
On the 835 ERA, CARC 260 appears alongside a group code that signals who is financially responsible for the adjustment. OA (Other Adjustment) — Informational or coordination-related adjustment. Usually means another payer is involved or there's a non-claim-related accounting entry.
Frequently asked questions
What does CARC 260 mean?
Processed under Medicaid ACA Enhanced Fee Schedule. In plain language: Processed under Medicaid ACA Enhanced Fee Schedule.
Is CARC 260 appealable?
CARC 260 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Which group code does CARC 260 appear under?
CARC 260 most often appears under: OA (Other Adjustment) — Informational or coordination-related adjustment. Usually means another payer is involved or there's a non-claim-related accounting entry.
What should I do if I see CARC 260 on the 835?
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Related resources
Sources
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