Credentialing Glossary
CARC
denial-managementDefinition
Claim Adjustment Reason Code. X12 standardized 308 codes (1 to 308) explaining why a claim line was adjusted. Always paired with a Group Code (CO, PR, OA, PI, PM) on the 835. Top frequency CARCs: 45 (charge exceeds fee schedule, 23% of all denials), 97 (service bundled), 16 (missing information), 50 (medical necessity), 109 (wrong payer). CARC list updated three times per year by X12.