Участник

Войдите в свою учетную запись, сделайте платеж, посмотрите льготы, и многое другое.

Участники

Управление планом

Полезные инструменты

Информация Medicare

Участники
Провайдер

Войдите в свою учетную запись, загрузите формы, просмотрите таблицы требований, и многое другое.

Поставщики услуг

Ресурсы провайдера

О наших планах

Полезные онлайн-инструменты

Поставщики услуг
Поиск плана

См. льготы плана, зоны обслуживания, цены, и многое другое.

Поиск плана

Наши планы

Полезные онлайн-инструменты

Wellcare от Fidelis Care

Поиск плана
AAA
Дом | Fidelis CareСтраховые брокеры Нью-Йорка

Добро пожаловать, Брокеры!

Fidelis Care обслуживает более 1,7 миллиона детей и взрослых всех возрастов, что делает нас одним из крупнейших планов медицинского страхования в штате Нью-Йорк. Мы были основаны на убеждении, что все жители Нью-Йорка должны иметь доступ к качественному и доступному медицинскому страхованию, и наша миссия помогать другим лежит в основе всего, что мы делаем. 

Последние новости


Fidelis Care Remittance Advice CARC/RARC Codes
02.05.2024 • Posted by Provider Relations in Provider News

Fidelis Care would like to inform providers about upcoming changes to our remittance advice.  Effective May 12, 2024, the Fidelis Care remittance advice will include Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC), along with a description of the codes.

 

CARCs describe why a claim or service line was paid differently than it was billed and RARCs provider additional explanation for an adjustment already described by a CARC or convey information about remittance advice. 

 

There are two types of RARCs, supplemental and informational.  The majority of RARCs are supplemental; these are generally referred to as RARCs without further distinction.  Supplemental RARCs provide additional explanation for an adjustment already described by the CARC.  The second type of RARC is informational; these RARCs are all prefaced with “Alert”. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC.

 

Sample of Applicable CARC and RAC Codes found on a Remittance Advice:

 

Explanation

Code

CARC/RARC Code

Description

K09

97/ N70

CARC: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

RARC: Consolidated billing and payment applies.

K03

97

CARC: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

Z03

23/N377

CARC: The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)

RARC: Payment based on a processed replacement claim.

BHX

45/ N860

CARC: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.

RARC: Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).

B95

226/ M143

CARC: Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

RARC: The provider must update license information with the payer.

i19

252/ N350

CARC: An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

RARC: Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.

 

 

If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please click here. 

 

Поиск врача

Поиск медицинского специалиста, поставщика услуг или медицинского учреждения в сети Fidelis Care.

Поиск

посетите нас!

Вопросы о медицинском страховании? Найдите ближайшее к вам отделение Fidelis Care.

Поиск отделения