Our providers have asked that our local reason codes be added to the 835 so we would send CARCs and RARCs and local codes that provide more detail for why the claim paid as it did. Is there a place this can be added to the 835 and still be compliant?
There is no location within the 835 transaction that is able to convey payer's local reject reasons or adjustment codes. Use of local codes is not compliant with the intent of the guide. There are a number of locations within the 835 that can be used to convey the same information held within a proprietary code, including but not limited to the LQ, SVC, CLP REF, and NM1 segments. If your providers have a business need for information that could possibly be conveyed in those segments, but is not currently supported by the guide, please bring that need to the X12 committee so it can be addressed in future versions of the guide.
If your business need could be met with a new or modified RARC or CARC code, you can file your request by selecting the appropriate Code List (CARC or RARC), then ‘Change Request Form’ at http://www.wpc-edi.com/reference/. When filing a request for a new or revised code, be sure to provide all the requested information, including a detailed business justification explaining why the change is needed.