Medicaid Secondary Claims Submitted with CARC Code 97

UPDATE: The NC Division of Medical Assistance (DMA) is suspending the new Medicaid secondary claims editing related to Claim Adjustment Reason Code (CARC) 97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated) that was communicated in the May 2017 Medicaid Special Bulletin.

For 90 days, beginning Sept. 25, 2017, NCTracks will allow the claim or claim line billed with primary payer CARC 97 to process and adjudicate without denying the claim or claim line with Explanation of Benefits (EOB) 01843 – MEDICAID DENIED DUE TO INDICATION OF PRIOR PAYER DENIAL.

This is a temporary change and will be applicable for all service dates while implemented. Before the 90-day time frame expires, a follow-up communication from DMA will be posted.

Important Instruction: It is very important the primary payer Claim Adjustment Group Code (CAGC) and CARC information be submitted to NCTracks, either by X12 batch transaction or via Provider portal, exactly as it appears on the primary payer EOB/Remittance. This includes accurately submitting codes at the header or detail claim line.

Guides and additional information: Providers submitting claims with primary payer details on the Provider Portal are encouraged to review the Provider User Guides and Training page for the How to Indicate Other Payer Details on a Claims In NCTracks and Batch Submission. This guide provides instruction for entering primary payer information such as CARCs, CAGCs and the adjustment amount.

For more information, contact the CSRA Call Center at 1-800-688-6696