Oakland Southfield Physicians

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Priority Health’s Changes to Remittance Advice (RA) and Explanation of Benefit (EOB) Codes Effective October 7, 2019

Posted: 11/01/2019

In response to recent provider feedback, Priority Health has identified areas for improvement and made changes in how they’re using some claim adjustment reason codes (CARCs).

What are CARCs?

A CARC is a national administrative code set that communicates a reason for a payment adjustment. It describes why a claim or service paid differently than how it was billed.

New information shared on the paper RA and EOB

The tables below reflect the changes effective October 7, 2019, for some CARC reporting for commercial, Medicare and Medicaid claims. These changes will affect the paper remittance advice and member explanation of benefits (EOB). The old CARC 252 will now be CARC 22 or CARC 19 with the new reason code and description.

New CARC 22 with the reason code and description

New CARC 19 with the reason code and description

New information shared on the electronic remits

Electronic remits only report the CARC code, and they do not include the reason code or description. The old CARC 252 will now be CARC 22 or CARC 19.

What do you need to do?

Update your system as needed, and if you have any questions, contact Priority Health’s Provider Services at provider.services@priorityhealth.com.

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