I am receiving an increased number of claims denying for primary insurance, what information should I transmit with the electronic file since I am not allowed to submit a hardcopy of the primary EOB?
When submitting payment information from a primary insurer it is necessary to include the amount billed to the primary; primary adjustment amount; primary approved amount; primary paid amount; and patient responsibility/contractual obligation, including the appropriate CARC code. The appropriate Claim Adjustment Reason Code (CARC) should be used to explain the reason for the adjustment. A complete list of these codes can be found at http://www.wpc-edi.com. Please refer to the DME MAC Jurisdiction C Supplier Manual, Chapter 11 for additional information.
