Testing for this transaction is not required. The 835 is also available for download through MassHealth’s point-to-point connectivity methods. Format requirements and applicable standards are listed in the Implementation Guide, which can be purchased from the Washington Publishing Company (WPC) website.
EOB/CARC & RARC Lists
Learn about MassHealth explanation of benefits (EOB) codes, the X12 Claim Adjustment Reason Codes (CARC), and Remittance Advice Remark Codes (RARC) that appear on 835 Electronic Remittance Advice transactions.
Claim Adjustment Reason Codes (CARC) explain why a claim or service line was adjudicated differently than it was billed. The only time a claim will not have an adjustment reason code is when the payment amount is equal to the billed amount.
Remittance Advice Remark Codes (RARC) are used within the 835 Health Care Remittance Advice and Payment Transaction in conjunction with the Claim Adjustment Reason Codes to convey information, and to provide clarification or a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code.
To facilitate the reconciliation of denied claims, the following CARC/RARC lists match the MassHealth explanation of benefits (EOB) codes to a corresponding Healthcare Claim Adjustment Reason Code, and when appropriate, a Remittance Advice Remark Code that appears on 835 transactions. Note: You should only reference these lists when reconciling denied claims.
The Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) manages the federally mandated CORE Code Combinations. CAQH reviews the X12 CARC and RARC codes and updates its CORE Code Combinations list quarterly. MassHealth aligns relevant EOBs with the mandated CORE Code Combinations and also updates EOBs, as required, to support claims processing. Please check this site periodically for the most current CARC/RARC lists.
If you have any questions about this information or would like to begin receiving the 835 transaction, contact MassHealth Customer Service by email at hipaasupport@mahealth.net or call (800) 841-2900, TDD/TTY: 711.
Additional Resources
| Last updated: | March 13, 2024 |
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