Since RFI 691 is longer available to reference, can a CARC be repeated in the same adjustment trio (for example, CAS02 and CAS05 when CAS01=CO), if the amounts net to 0?
The CAGC/CARC CO 137 is used twice for some state surcharge requirements. Due to electing and non-electing components of the regulatory surcharge RFI 691 was submitted to request consideration of using the GC/CARC CO 137 twice.
The example below shows CO 137 as a positive amount and a negative amount in order to inform providers of those amounts when they have elected the health plan to submit state surcharge (regulatory) amounts to the state on their behalf.
The 4.07 is paid to the state. 6.79 is total surcharge amount. 2.72 is the amount that patient is liable for the surcharge to pay the provider and provider sends to state. The 1.20 is the patient’s coinsurance (CARC 2) and not part of the surcharge amount. (**2*1.2~)
Please refer to the situational rule under loop 2100 & 2110 CAS Segment element 05. “SITUATIONAL RULE: Required when an additional non-zero adjustment, beyond what has already been supplied, applies to the claim adjustment group code used in CAS01. If not required by this implementation guide, do not send.”
Repeating a claim adjustment reason code (CARC), within a given CAS segment is not allowed.