CARC (Claim Adjustment Reason Code)
A numeric code on insurance EOBs and 835 ERAs explaining why a claim was reduced, denied, or adjusted.
CARC codes are numeric codes published by ASC X12 that explain claim-level adjustments. They appear on the 835 ERA and on patient EOBs. Each CARC pairs with a group code (CO, PR, OA, PI) indicating who owes the money. Common CARCs: 50 (medical necessity), 197 (prior auth absent), 96 (not covered), 204 (excluded benefit).
Frequently asked questions
What is carc (claim adjustment reason code)?
CARC codes are numeric codes published by ASC X12 that explain claim-level adjustments. They appear on the 835 ERA and on patient EOBs. Each CARC pairs with a group code (CO, PR, OA, PI) indicating who owes the money. Common CARCs: 50 (medical necessity), 197 (prior auth absent), 96 (not covered), 204 (excluded benefit).
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