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Use this sitemap to find QuickIntell product pages, healthcare RCM guides, EHR integrations, resources, company pages, and operational reference directories.
Products
- Products
- AI RCM
- QuickRCM - End-to-End RCM
- QuickCode - AI Medical Coding
- QuickAuth - Prior Authorization
- QuickScribe - AI Medical Scribe
- QuickVoice
- QuickVoice Voice Agents
- QuickEHR
- QuickERA - EOB to ERA
- Claims Filing
- Eligibility Verification
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- Denial Management
- Inpatient Billing
- Cost Estimator
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- Risk Adjustment Coding
- Risk Adjustment HCC
- AI RCM Accounts Receivable
- AI RCM Insurance Discovery
- AI RCM Prior Authorization
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- AI RCM Claims Processing
- AI RCM Document Classification
- AI RCM Coding Notes Review
- AI RCM Denials Management
- AI RCM Eligibility Verification
- AI RCM EOB to ERA
- End-to-End AI RCM
- Risk Adjustment Technology
- Retrospective Chart Reviews
- Clinical Decision Support
- Prospective Risk Adjustment
- Risk Adjustment Healthcare API
- Voice Agents for Providers
- Voice Agents for Payors
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Integrations
Content Library
Comparisons
- Quickintell vs. Athelas
- Quickintell vs. Adonis
- Quickintell vs. Thoughtful AI
- Quickintell vs. Athenahealth
- Best AI RCM Software
- QuickIntell vs. Waystar
- Quickintell vs. R1 RCM
- Quickintell vs. Epic RCM
- QuickIntell vs. Optum
- Best AI Medical Scribe
- Best AI Medical Coding Software
- RCM Outsourcing vs. AI Automation
- Best RCM Software
- Healthcare RCM Software Guide
- Quickintell vs. Eclinicalworks
- Quickintell vs. Nextgen
- Quickintell vs. Notable
- Quickintell vs. Akasa
- Quickintell vs. Infinx
- Best AI Prior Auth Software
- Quickintell vs. Fathom Health
- Quickintell vs. Abridge
- Quickintell vs. Codametrix
- Quickintell vs. Olive AI
- Best AI Denial Management Software
- Best AI Eligibility Verification Software
- Best AI Medical Billing Software
- Quickintell vs. Kareo
Insights & Thought Leadership
- Payer Provider AI Arms Race
- 400 Billion Healthcare Waste
- Spotting AI Washing Healthcare
- Healthcare Cfo Guide To AI
- Payer Provider AI Claims Adjudication
- Medical Coder Shortage Evolution
- Healthcare AI Landscape 2026
- Building AI For Healthcare Founder Story
- AI Agents In Healthcare
- Future Of Medical Coding
- Cms Interoperability Rules 2026
- AI Transforming Healthcare 2026
- Predictive Analytics Revenue Cycle
- Agentic AI In Healthcare
- Generative AI In Healthcare
- Llms In Healthcare
- State Of Healthcare Denials 2026
- AI Healthcare Claims Processing
- AI Patient Scheduling
- AI Insurance Verification
- Administrative Burden Crisis
- AI First Revenue Cycle
- Voice AI Healthcare
- Proof And ROI
- Trust Compliance Governance
- Human Plus AI Workforce
Medical Coding & RCM Reference Guides | QuickIntell
- Medical Coding
- CPT Codes Explained
- Diagnosis Codes ICD-10
- How Medical Billing Works
- Revenue Cycle Analytics
- Medical Billing Automation
- HCC Coding
- What Is Revenue Cycl__emanagement
- Revenue Cycl__emanagement Companies
- Workers Compensation Billing
- Coordination Of Benefits
- What Is Prior Authorization
- What Is Clinical Documentation Improvement
- What Is A Superbill
- What Is Explanation Of Benefits
- What Is A Medical Clearinghouse
- What Is Charge Capture
- What Is Hcpcs Coding
- What Is A Medical Claim
- What Is AI Medical Coding
- What Is Accounts Receivable Healthcare
- What Is An AI Revenue Agent
- AI Voice Agents In RCM
- How To Write A Medical Necessity Appeal
- Oig And Sam Monthly Screening Explained
- Good Faith Estimate 101 No Surprises Act
- Payer Credentialing And Enrollment 101
- Medical Billing Clearinghouse
- Best Clearinghouse For Medical Billing
- Top Clearinghouses Medical Billing
- List Of Clearinghouses In Medical Billing
- Healthcare Clearinghouse Companies
- Medical Billing Clearinghouse Cost
- Fre__emedical Billing Clearinghouse
- Medical Billing Software With Clearinghouse
- 837 Claims Clearinghouse
- 835 Era Clearinghouse
- Clearinghouse Eligibility Verification
- Openemr Clearinghouse
AI RCM Resources for Healthcare Revenue Cycle Leaders
- RCM Migration Playbook
- AI RCM Implementation Timeline
- Build Business Case AI RCM
- Questions To Ask AI RCM Demo
- Soc2 HIPAA Certifications
- Radiology Denial Reduction Case Study
- Prior Auth Automation Case Study
- Emergency Medicine Coding Case Study
- Home Health AR Case Study
- Asc Clean Claim Case Study
- Cardiology Denial Reduction Case Study
- Multi Specialty Prior Auth Case Study
- Primary Care AI Scribe Case Study
- RCM Company Scaling Case Study
- Community Hospital AR Case Study
- Risk Adjustment Faq
- Family Medicine Faq
- Fqhc Uds Readiness
- No Surprises Act
Payer Guides
- Unitedhealthcare Prior Authorization
- Aetna Prior Authorization
- Cigna Prior Authorization
- Humana Prior Authorization
- BCBS Prior Authorization
- Anthem Prior Authorization
- Aetna Eligibility Verification
- Cigna Eligibility Verification
- Unitedhealthcare Eligibility Verification
- Medicare Eligibility Verification
- Urgent Care CPT Codes
- Podiatry CPT Codes
- Dermatology CPT Codes
- Emergency Medicine CPT Codes
- Cardiology CPT Codes
- Orthopedic CPT Codes
- Obgyn CPT Codes
- Gastroenterology CPT Codes
- Neurology CPT Codes
- Ophthalmology CPT Codes
- Medicare Advantage Billing
- Medicaid Prior Authorization
- Tricare Prior Authorization Billing
- Medicaid Eligibility Verification
- Humana Eligibility Verification
- BCBS Eligibility Verification
Who We Serve
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Payers
- Payers Directory
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- Beacon Health Options
- BHHC
- Blue Cross of Idaho
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- CalOptima Health
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- Capital Rx
- CareCredit
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- CGS Administrators
- CHAMPVA
- ChenMed
- CHRISTUS Health Plan
- Chubb
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- Cigna Medicare
- Cityblock Health
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- CNA Insurance
- Cofinity
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- Community First Health Plans
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- Community Health Plan of Washington
- CommunityCare Oklahoma
- Contra Costa Health Plan
- CorVel
- Crawford & Company
- CVS Caremark
- Cypress Benefit Administrators
- Davis Vision
- Delta Dental
- Dental Select
- DentaQuest
- DenteMax
- Devoted Health
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- Elixir Rx
- EmblemHealth
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- EMPLOYERS
- eQHealth
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- Essence Healthcare
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- eviCore
- Excellus BCBS
- Express Scripts
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- First Coast Medicare
- First Health Network
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- Healthfirst
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- HM Insurance Group
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- Humana
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- Independence Blue Cross
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- Johns Hopkins HealthCare
- Kaiser Permanente
- KEPRO
- Kern Health Systems
- Key Benefit Administrators
- Keystone First
- L.A. Care
- LIBERTY Dental Plan
- Liberty Mutual
- Lincoln Financial
- Luminare Health
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- Managed Dental Care
- MARCH Vision
- Markel
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- Maryland Physicians Care
- Mass General Brigham Health Plan
- MCG Health
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- Medica
- Medicaid (Generic Reference)
- Medical Mutual
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- MedImpact
- MedRisk
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- Meridian Health Plan
- Meritain Health
- MES Solutions
- MetLife Dental
- MetroPlus Health
- Mitchell
- Molina Healthcare
- Molina Washington
- MultiPlan
- Mutual of Omaha
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- Nationwide
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- NGS Medicare
- Noridian
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- NVA
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- Oak Street Health
- Ohio BWC
- One Call
- OptiCare
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- Optum
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- Oscar Health
- Oxford Health Plans
- Palmetto GBA
- Parkland Community Health Plan
- Partnership HealthPlan of California
- Passport Health Plan
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- Pinnacol Assurance
- PMA Companies
- Premera Blue Cross
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- Prime Therapeutics
- Principal Financial
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- Railroad Medicare
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- Rocky Mountain Health Plans
- Safety National
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- SCAN Health Plan
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- Sentara Health Plans
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- Superior HealthPlan
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- United Concordia
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- UPMC for You
- UPMC Health Plan
- USAA
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- WebTPA
- WellCare
- Wellmark Blue Cross Blue Shield
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- Westfield Insurance
- WPS Medicare
- Zenith American Solutions
- Zenith Insurance
- Zing Health
- Zurich Insurance
Denials
Reference Hubs
CARC Codes
- CARC 1 - Deductible Amount
- CARC 4 - The procedure code is inconsistent with the modifier used or a requir...
- CARC 11 - The diagnosis is inconsistent with the procedure.
- CARC 16 - Claim/service lacks information or has submission/billing error(s).
- CARC 18 - Exact duplicate claim/service
- CARC 22 - This care may be covered by another payer per coordination of benefits.
- CARC 23 - The impact of prior payer(s) adjudication including payments and/or a...
- CARC 24 - Charges are covered under a capitation agreement/managed care plan.
- CARC 27 - Expenses incurred after coverage terminated.
- CARC 29 - The time limit for filing has expired.
- CARC 31 - Patient cannot be identified as our insured.
- CARC 45 - Charge exceeds fee schedule/maximum allowable or contracted/legislate...
- CARC 50 - These are non-covered services because this is not deemed a 'medical...
- CARC 54 - Multiple physicians/assistants are not covered in this case.
- CARC 96 - Non-covered charge(s).
- CARC 97 - The benefit for this service is included in the payment/allowance for...
- CARC 109 - Claim/service not covered by this payer/contractor. You must send the...
- CARC 119 - Benefit maximum for this time period or occurrence has been reached.
- CARC 125 - Submission/billing error(s). Usage: Refer to the 835 Healthcare Polic...
- CARC 150 - Payer deems the information submitted does not support this level of...
- CARC 167 - This (these) diagnosis(es) is (are) not covered.
- CARC 181 - Procedure code was invalid on the date of service.
- CARC 197 - Precertification/authorization/notification/pre-treatment absent.
- CARC 204 - This service/equipment/drug is not covered under the patient's curren...
- CARC 226 - Information requested from the Billing/Rendering Provider was not pro...
- CARC 231 - Mutually exclusive procedures cannot be done in the same day/setting.
- CARC B7 - This provider was not certified/eligible to be paid for this procedur...
- CARC B9 - Patient is enrolled in a Hospice.
- CARC B15 - This service/procedure requires that a qualifying service/procedure b...
- CARC 252 - An attachment/other documentation is required to adjudicate this clai...
- CARC B13 - Previously paid. Payment for this claim/service may have been provide...
- CARC A1 - Claim/Service denied. At least one Remark Code must be provided (may...
- CARC 227 - Information requested from the Billing/Rendering Provider was not pro...
- CARC 151 - Payment adjusted because the payer deems the information submitted do...
- CARC 243 - Services not authorized by network/primary care providers.
- CARC 59 - Processed based on multiple or concurrent procedure rules.
- CARC 242 - Services not provided by network/primary care providers.
- CARC 234 - This procedure is not paid separately.
- CARC 55 - Procedure/treatment/drug is deemed experimental/investigational by th...
- CARC 236 - This procedure or procedure/modifier combination is not compatible wi...
- CARC 26 - Expenses incurred prior to coverage.
- CARC 107 - The related or qualifying claim/service was not identified on this cl...
- CARC 129 - Prior processing information appears incorrect.
- CARC 39 - Services denied at the time authorization/pre-certification was reque...
- CARC 253 - Sequestration - reduction in federal payment.
- CARC 256 - Service not payable per managed care contract.
- CARC 272 - Coverage/program guidelines were not met.
- CARC 288 - Referral absent.
- CARC B11 - The claim/service has been transferred to the proper payer/processor...
- CARC 5 - The procedure code/type of bill is inconsistent with the place of ser...
- CARC 49 - This is a non-covered service because it is a routine/preventive exam...
- CARC 170 - Payment is denied when performed/billed by this type of provider.
- CARC 177 - Patient has not met the required eligibility requirements.
- CARC 216 - Based on the findings of a review organization.
- CARC 222 - Exceeds the contracted maximum number of hours/days/units by this pro...
- CARC 2 - Coinsurance Amount.
- CARC 8 - The procedure code is inconsistent with the provider type/specialty (...
- CARC 95 - Plan procedures not followed.
- CARC 131 - Claim specific negotiated discount.
- CARC 133 - The disposition of this service line is pending further review.
- CARC 185 - The rendering provider is not eligible to perform the service billed.
- CARC 193 - Original payment decision is being maintained. Upon review, it was de...
- CARC 198 - Precertification/notification/authorization/pre-treatment exceeded.
- CARC 200 - Expenses incurred during lapse in coverage.
- CARC 273 - Coverage/program guidelines were exceeded.
- CARC 284 - Precertification/authorization/notification/pre-treatment number may...
- CARC 286 - Appeal procedures not followed.
- CARC B16 - 'New Patient' qualifications were not met.
- CARC 32 - Our records indicate that this dependent is not an eligible dependent...
- CARC 21 - This injury/illness is the liability of the no-fault carrier.
- CARC 3 - Co-payment Amount.
- CARC 146 - Diagnosis was invalid for the date(s) of service reported.
- CARC 147 - Provider contracted/negotiated rate expired or not on file.
- CARC 163 - Attachment/other documentation referenced on the claim was not received.
- CARC 208 - National Provider Identifier - Not matched.
- CARC 251 - The attachment/other documentation that was received was incomplete o...
- CARC 58 - Treatment was deemed by the payer to have been rendered in an inappro...
- CARC B10 - Allowed amount has been reduced because a component of the basic proc...
- CARC B20 - Procedure/service was partially or fully furnished by another provider.
- CARC 40 - Charges do not meet qualifications for emergent/urgent care.
- CARC 9 - The diagnosis is inconsistent with the patient's age.
- CARC 15 - The authorization number is missing, invalid, or does not apply to th...
- CARC 20 - This injury/illness is covered by the liability carrier.
- CARC 6 - The procedure/revenue code is inconsistent with the patient's age.
- CARC 136 - Failure to follow prior payer's coverage rules.
- CARC 182 - Procedure modifier was invalid on the date of service.
- CARC 206 - National Provider Identifier - missing.
- CARC 246 - This non-payable code is for required reporting only.
- CARC 276 - Services denied by the prior payer(s) are not covered by this payer.
- CARC 7 - The procedure/revenue code is inconsistent with the patient's gender.
- CARC 30 - Payment adjusted because the patient has not met the required eligibi...
- CARC 183 - The referring provider is not eligible to refer the service billed.
- CARC 187 - Consumer Spending Account payments (includes but is not limited to Fl...
- CARC 201 - Workers' Compensation case settled. Patient is responsible for amount...
- CARC 261 - The procedure or service is inconsistent with the patient's history.
- CARC 10 - The diagnosis is inconsistent with the patient's gender.
- CARC 12 - The diagnosis is inconsistent with the provider type.
- CARC 13 - The date of death precedes the date of service.
- CARC 14 - The date of birth follows the date of service.
- CARC 35 - Lifetime benefit maximum has been reached.
- CARC 41 - Discount agreed to in Preferred Provider contract.
- CARC 42 - Charges exceed our fee schedule or maximum allowable amount.
- CARC 44 - Prompt-pay discount.
- CARC 47 - This (these) diagnosis(es) is (are) not covered, missing, or are inva...
- CARC 52 - The referring/prescribing/rendering provider is not eligible to refer...
- CARC 62 - Payment denied/reduced for absence of, or exceeded, pre-certification...
- CARC 65 - Procedure code was incorrect. This payment reflects the correct code.
- CARC 66 - Blood Deductible.
- CARC 70 - Cost outlier - Adjustment to compensate for additional costs.
- CARC 74 - Indirect Medical Education Adjustment.
- CARC 75 - Direct Medical Education Adjustment.
- CARC 77 - Covered days.
- CARC 78 - Non-Covered days/Room charge adjustment.
- CARC 87 - Transfer amount.
- CARC 88 - Adjustment amount represents collection against receivable created in...
- CARC 89 - Professional fees removed from charges.
- CARC 90 - Ingredient cost adjustment.
- CARC 91 - Dispensing fee adjustment.
- CARC 100 - Payment made to patient/insured/responsible party.
- CARC 101 - Predetermination: anticipated payment upon completion of services or...
- CARC 102 - Major Medical Adjustment.
- CARC 103 - Provider promotional discount (e.g., Senior citizen discount).
- CARC 104 - Managed care withholding.
- CARC 105 - Tax withholding.
- CARC 108 - Rent/purchase guidelines were not met.
- CARC 111 - Not covered unless the provider accepts assignment.
- CARC 114 - Procedure/product not approved by the Food and Drug Administration.
- CARC 115 - Procedure postponed, canceled, or delayed.
- CARC 116 - The advance indemnification notice signed by the patient did not comp...
- CARC 122 - Psychiatric reduction.
- CARC 128 - Newborn's services are covered in the mother's Allowance.
- CARC 140 - Patient/Insured health identification number and name do not match.
- CARC 149 - Lifetime benefit maximum has been reached for this service/benefit ca...
- CARC 152 - Payer deems the information submitted does not support this length of...
- CARC 166 - These services were submitted after this payer's responsibility for p...
- CARC 168 - Service(s) have been considered under the patient's medical plan. Ben...
- CARC 178 - Payment adjusted because the patient has not met the required spend d...
- CARC 180 - Patient has not met the required residency requirements.
- CARC 186 - Level of care change adjustment.
- CARC 188 - This product/procedure is only covered when used according to FDA rec...
- CARC 190 - Payment is included in the allowance for a Skilled Nursing Facility (...
- CARC 192 - Non standard adjustment code from paper remittance.
- CARC 205 - Pharmacy discount card processing fee.
- CARC 210 - Payment adjusted because pre-certification/authorization not received...
- CARC 219 - Based on extent of injury.
- CARC 221 - Workers' Compensation claim adjudicated as non-compensable.
- CARC 229 - Partial charge amount not considered by Medicare due to the initial c...
- CARC 249 - This claim has been identified as a readmission.
- CARC 275 - Prior payer's (or payers') patient responsibility (deductible, coinsu...
- CARC A5 - Medicare Claim PPS Capital Cost Outlier Amount.
- CARC 19 - This is a work-related injury/illness and thus the liability of the W...
- CARC 33 - Insured has no dependent coverage.
- CARC 34 - Insured has no coverage for newborns.
- CARC 51 - These are non-covered services because this is a pre-existing condition.
- CARC 53 - Services by an immediate relative or a member of the same household a...
- CARC 56 - Procedure/treatment has not been deemed 'proven to be effective' by t...
- CARC 60 - Charges for outpatient services are not covered when performed within...
- CARC 61 - Adjustment for failure to obtain second surgical opinion.
- CARC 69 - Day outlier amount.
- CARC 76 - Disproportionate Share Adjustment.
- CARC 85 - Patient Interest Adjustment (Use Only Group code PR).
- CARC 94 - Processed in Excess of charges.
- CARC 106 - Patient payment option/election not in effect.
- CARC 110 - Billing date predates service date.
- CARC 112 - Service not furnished directly to the patient and/or not documented.
- CARC 117 - Transportation is only covered to the closest facility that can provi...
- CARC 118 - ESRD network support adjustment.
- CARC 121 - Indemnification adjustment - compensation for outstanding member resp...
- CARC 130 - Claim submission fee.
- CARC 132 - Prearranged demonstration project adjustment.
- CARC 134 - Technical fees removed from charges.
- CARC 135 - Interim bills cannot be processed.
- CARC 137 - Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
- CARC 139 - Contracted funding agreement - Subscriber is employed by the provider...
- CARC 142 - Monthly Medicaid patient liability amount.
- CARC 143 - Portion of payment deferred.
- CARC 144 - Incentive adjustment, e.g. preferred product/service.
- CARC 148 - Information from another provider was not provided or was insufficien...
- CARC 153 - Service/procedure was provided as a result of an act of war.
- CARC 154 - Payer deems the information submitted does not support this dosage.
- CARC 155 - Patient refused the service/procedure.
- CARC 157 - Service/procedure was provided as a result of an act of war.
- CARC 158 - Service/procedure was provided outside of the United States.
- CARC 159 - Service/procedure was provided as a result of terrorism.
- CARC 160 - Injury/illness was the result of an activity that is a benefit exclus...
- CARC 161 - Provider performance bonus.
- CARC 164 - Attachment/other documentation referenced on the claim was not receiv...
- CARC 169 - Alternate benefit has been provided.
- CARC 171 - Payment is denied when performed/billed by this type of provider in t...
- CARC 172 - Payment is adjusted when performed/billed by a provider of this speci...
- CARC 173 - Service/equipment was not prescribed by a physician.
- CARC 174 - Service was not prescribed prior to delivery.
- CARC 175 - Prescription is incomplete.
- CARC 176 - Prescription is not current.
- CARC 179 - Patient has not met the required waiting requirements.
- CARC 184 - The prescribing/ordering provider is not eligible to prescribe/order...
- CARC 189 - 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) w...
- CARC 199 - Revenue code and Procedure code do not match.
- CARC 202 - Non-covered personal comfort or convenience services.
- CARC 203 - Discontinued or reduced service.
- CARC 207 - National Provider Identifier - Invalid format.
- CARC 209 - Per regulatory or other agreement, the provider cannot collect this a...
- CARC 211 - National Drug Code (NDC) is not eligible for rebate.
- CARC 212 - Administrative surcharges are not covered.
- CARC 213 - Non-compliance with the physician self referral prohibition legislati...
- CARC 215 - Based on subrogation of a third party settlement.
- CARC 223 - Adjustment code for mandated federal, state or local law/regulation t...
- CARC 224 - Patient identification compromised by identity theft. Identity verifi...
- CARC 225 - Penalty or Interest Payment by Payer (Only used for plan to plan enco...
- CARC 228 - Denied for failure of this provider, payer or subscriber to supply re...
- CARC 232 - Institutional Transfer Amount.
- CARC 233 - Services/charges related to the treatment of a hospital-acquired cond...
- CARC 235 - Sales Tax.
- CARC 237 - Legislated/Regulatory Penalty.
- CARC 238 - Claim spans eligible and ineligible periods of coverage.
- CARC 239 - Claim spans eligible and ineligible periods of coverage. Rebill separ...
- CARC 240 - The diagnosis is inconsistent with the patient's birth weight.
- CARC 241 - Low Income Subsidy (LIS) Co-payment Amount.
- CARC 245 - Provider performance program withhold.
- CARC 247 - Deductible for Professional service rendered in an Institutional sett...
- CARC 248 - Coinsurance for Professional service rendered in an Institutional set...
- CARC 250 - The attachment/other documentation that was received was the incorrec...
- CARC 254 - Claim received by the dental plan, but benefits not available under t...
- CARC 257 - The disposition of the related Property & Casualty claim (injury or i...
- CARC 258 - Claim/service not covered when patient is in custody/incarcerated.
- CARC 259 - Additional payment for Dental/Vision service utilization.
- CARC 260 - Processed under Medicaid ACA Enhanced Fee Schedule.
- CARC 262 - Adjustment for delivery cost.
- CARC 263 - Adjustment for shipping cost.
- CARC 264 - Adjustment for postage cost.
- CARC 265 - Adjustment for administrative cost.
- CARC 266 - Adjustment for compound preparation cost.
- CARC 267 - Claim/service spans multiple months.
- CARC 268 - The Claim spans two calendar years. Please resubmit one claim per cal...
- CARC 269 - Anesthesia not covered for this service/procedure.
- CARC 270 - Claim received by the medical plan, but benefits not available under...
- CARC 271 - Prior contractual reductions related to a current periodic payment as...
- CARC 274 - Fee/Service not payable per patient Care Coordination arrangement.
- CARC 278 - Performance program proficiency requirements not met.
- CARC 279 - Services not provided by Preferred network providers.
- CARC 280 - Claim received by the medical plan, but benefits not available under...
- CARC 281 - Deductible waived per contractual agreement.
- CARC 282 - The procedure/revenue code is inconsistent with the type of bill.
- CARC 283 - Attending provider is not eligible to provide direction of care.
- CARC 285 - Appeal procedures not followed.
- CARC 287 - Referral exceeded.
- CARC 289 - Services considered under the dental and medical plans, benefits not...
- CARC 290 - Claim received by the medical plan, but benefits not available under...
- CARC 291 - Claim received by the dental plan, but benefits not available under t...
- CARC 292 - Claim received by the medical plan, but benefits not available under...
- CARC 293 - Payment made to employer.
- CARC 294 - Payment made to attorney.
- CARC 295 - Pharmacy Direct/Indirect Remuneration (DIR).
- CARC 296 - Precertification/notification number does not apply to the specified...
- CARC 297 - Claim received by the medical plan, but benefits not available under...
- CARC 298 - Claim received by the medical plan, but benefits not available under...
- CARC 299 - The billing provider is not eligible to receive payment for the servi...
- CARC 300 - Claim received by the medical plan, but benefits not available under...
- CARC 301 - Claim received by the medical plan, but benefits not available under...
- CARC 302 - Precertification/notification number provided is no longer valid.
- CARC 303 - Prior payer's (or payers') patient responsibility (deductible, coinsu...
- CARC 304 - Claim received by the medical plan, but benefits not available under...
- CARC 305 - Claim received by the medical plan, but benefits not available under...
- CARC 306 - Type of bill is inconsistent with patient status.
- CARC 307 - Payment adjusted based on the Medicare Maximum Fair Price Standard.
- CARC 308 - Adjustment based on contracted funding agreement rate vs the amount b...
- CARC A0 - Patient refund amount.
- CARC A6 - Prior hospitalization or 30 day transfer requirement not met.
- CARC A8 - Ungroupable DRG.
- CARC B1 - Non-covered visits.
- CARC B4 - Late filing penalty.
- CARC B12 - Services not documented in patient's medical records.
- CARC B14 - Only one visit or consultation per physician per day is covered.
- CARC B23 - Procedure billed is not authorized per the Clinical Laboratory Improv...
- CARC P1 - State-mandated Requirement for Property and Casualty, see Claim Payme...
- CARC P2 - Not a work related injury/illness and thus not the liability of the w...
- CARC P3 - Workers' Compensation case settled, patient is responsible for furthe...
- CARC P4 - Workers' Compensation claim adjudicated as non-compensable.
- CARC P5 - Based on payer reasonable and customary fees. No maximum allowable de...
- CARC P6 - Based on entitlement to benefits.
- CARC P7 - The applicable fee schedule/fee database does not contain the billed...
- CARC P8 - Claim is under investigation.
- CARC P9 - No available or correlating CPT/HCPCS code to describe this service.
- CARC P10 - Payment reduced to zero due to litigation. Additional information wil...
- CARC P11 - The disposition of the claim/service is undetermined during the premi...
- CARC P12 - Workers' compensation jurisdictional fee schedule adjustment.
- CARC P13 - Payment reduced or denied based on workers' compensation jurisdiction...
- CARC P14 - The Benefit for this Service is included in the payment/allowance for...
- CARC P15 - Workers' Compensation Medical Treatment Guideline Adjustment.
- CARC P16 - Medical provider not authorized/certified to provide treatment to inj...
- CARC P17 - Referral not authorized by attending physician per regulatory require...
- CARC P18 - Procedure is not listed in the jurisdiction fee schedule. An allowanc...
- CARC P19 - Procedure has a relative value of zero in the jurisdiction fee schedu...
- CARC P20 - Service not paid under jurisdictional regulations or payment policies...
- CARC P21 - Payment denied based on Medical Payments Coverage (MPC) or Personal I...
- CARC P22 - Payment adjusted based on MPC or PIP Benefits jurisdictional regulati...
- CARC P23 - Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) B...
- CARC P24 - Payment adjusted based on Preferred Provider Organization (PPO).
- CARC P25 - Payment adjusted based on Medical Provider Network (MPN).
- CARC P26 - Payment adjusted based on Voluntary Provider network (VPN).
- CARC P27 - Payment denied based on the Liability Coverage Benefits jurisdictiona...
- CARC P28 - Payment adjusted based on Liability Coverage Benefits jurisdictional...
- CARC P29 - Liability Benefits jurisdictional fee schedule adjustment.
- CARC P30 - Exacerbation of previous condition denied due to incomplete medical d...
- CARC P31 - Exacerbation of previous condition denied due to treatment exceeding...
- CARC P32 - Payment adjusted due to Apportionment as determined by the Workers' C...
RARC Codes
- RARC M15 - Separately billed services/tests have been bundled as they are consid...
- RARC M25 - The information furnished does not substantiate the need for this lev...
- RARC M62 - Missing/incomplete/invalid treatment authorization code.
- RARC M80 - Not covered when performed during the same session/date as a previous...
- RARC N4 - Missing/Incomplete/Invalid prior insurance carrier EOB.
- RARC N20 - Service not payable with other service rendered on the same date.
- RARC N115 - This decision was based on a Local Coverage Determination (LCD). An L...
- RARC N130 - Consult plan benefit documents/guidelines for information about restr...
- RARC N362 - The number of Days or Units of Service exceeds our acceptable maximum.
- RARC N386 - This decision was based on a National Coverage Determination (NCD).
- RARC N381 - Alert: Consult our contractual agreement for restrictions/billing/pay...
- RARC M51 - Missing/incomplete/invalid procedure code(s).
- RARC N706 - Missing documentation.
- RARC M76 - Missing/incomplete/invalid diagnosis or condition.
- RARC M127 - Missing patient medical record for this service.
- RARC N30 - Patient ineligible for this service.
- RARC N19 - Procedure code incidental to primary procedure.
- RARC N418 - Misrouted claim. See the payer's claim submission instructions.
- RARC N56 - Procedure code billed is not correct/valid for the services billed or...
- RARC N382 - Missing/incomplete/invalid patient identifier.
- RARC M86 - Service denied because payment already made for same/similar procedur...
- RARC N290 - Missing/incomplete/invalid rendering provider primary identifier.
- RARC N245 - Incomplete/invalid plan information for other insurance.
- RARC N211 - Alert: You may not appeal this decision.
- RARC N569 - Not covered when performed for the reported diagnosis.
- RARC N598 - Health care policy coverage is primary.
- RARC N522 - Duplicate of a claim processed, or to be processed, as a crossover cl...
- RARC M77 - Missing/incomplete/invalid/inappropriate place of service.
- RARC N525 - These services are not covered when performed within the global perio...
- RARC N179 - Additional information has been requested from the member. The charge...
- RARC N257 - Missing/incomplete/invalid billing provider/supplier primary identifier.
- RARC M119 - Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (...
- RARC N255 - Missing/incomplete/invalid billing provider taxonomy.
- RARC N216 - We do not offer coverage for this type of service or the patient is n...
- RARC N220 - Alert: See the payer's web site or contact the payer's Customer Servi...
- RARC N286 - Missing/incomplete/invalid referring provider primary identifier.
- RARC M81 - You are required to code to the highest level of specificity.
- RARC N95 - This provider type/provider specialty may not bill this service.
- RARC N16 - Family/member Out-of-Pocket maximum has been met. Payment based on a...
- RARC N10 - Adjustment based on a medical/dental provider's initial determination.
- RARC N34 - Incorrect claim form/format for this service.
- RARC M115 - This item is denied when provided to this patient by a non-contract o...
- RARC M47 - Missing/incomplete/invalid internal or document control number.
- RARC M144 - Pre-/post-operative care payment is included in the allowance for the...
- RARC N59 - Please refer to your provider manual for additional program and provi...
- RARC N265 - Missing/incomplete/invalid ordering provider primary identifier.
- RARC M53 - Missing/incomplete/invalid days or units of service.
- RARC M60 - Missing Certificate of Medical Necessity.
- RARC N122 - Add-on code cannot be billed by itself.
- RARC N52 - Patient not enrolled in the billing provider's managed care plan on t...
- RARC N54 - Claim information is inconsistent with pre-certified/authorized servi...
- RARC N264 - Missing/incomplete/invalid ordering provider name.
- RARC N431 - Service is not covered with this procedure.
- RARC N650 - This policy was not in effect for this date of loss. No coverage is a...
- RARC M20 - Missing/incomplete/invalid HCPCS code.
- RARC N45 - Payment based on authorized amount.
- RARC M16 - Alert: Please see our Web site, mailing, bulletin, or other publicati...
- RARC N123 - This is a split service and represents a portion of the units from th...
- RARC N104 - This claim/service is not payable under our claims jurisdiction area....
- RARC N65 - Procedure code or procedure rate count cannot be determined, or was n...
- RARC N356 - Not covered when performed with, or subsequent to, a non-covered serv...
- RARC N1 - Alert: You may appeal this decision in writing within the required ti...
- RARC N22 - This procedure code was added/changed because it more accurately desc...
- RARC M50 - Missing/incomplete/invalid revenue code(s).
- RARC M67 - Missing/incomplete/invalid other procedure code(s).
- RARC N294 - Missing/incomplete/invalid service facility primary identifier.
- RARC N435 - Exceeds number/frequency approved/allowed within time period without...
- RARC M56 - Missing/incomplete/invalid payer identifier.
- RARC M49 - Missing/incomplete/invalid value code(s) or amount(s).
- RARC M54 - Missing/incomplete/invalid total charges.
- RARC M2 - Not paid separately when the patient is an inpatient.
- RARC N289 - Missing/incomplete/invalid rendering provider name.
- RARC N345 - Date range not valid with units submitted.
- RARC N35 - Program integrity/utilization review decision.
- RARC N480 - Incomplete/invalid Explanation of Benefits (EOB).
- RARC M13 - Only one initial visit is covered per specialty per medical group.
- RARC N26 - Missing itemized bill/statement.
- RARC M79 - Missing/incomplete/invalid charge.
- RARC M52 - Missing/incomplete/invalid 'from' date(s) of service.
- RARC M41 - We do not pay for this as the patient has no legal obligation to pay...
- RARC N29 - Missing documentation/orders/notes/summary/report/chart.
- RARC N58 - Missing/incomplete/invalid patient liability amount.
- RARC N280 - Missing/incomplete/invalid pay-to provider primary identifier.
- RARC N329 - Missing/incomplete/invalid patient birth date.
- RARC N450 - Covered only when performed by the primary treating physician or the...
- RARC N206 - The supporting documentation does not match the claim/service.
- RARC M4 - Alert: This may involve a question of fact that may be addressed by t...
- RARC M17 - Alert: Payment approved as you did not know, and could not reasonably...
- RARC M18 - Certain services may be approved for home use. Neither a hospital nor...
- RARC M28 - This does not qualify for payment under Part B when Part A coverage i...
- RARC M30 - Missing pathology report.
- RARC M31 - Missing radiology report.
- RARC M126 - Missing/incomplete/invalid individual lab codes included in the test.
- RARC M130 - Missing invoice or statement certifying the actual cost of the lens,...
- RARC M143 - The provider must update license information with the payer.
- RARC N5 - EOB/EOMB reflects prior payer's payment or patient responsibility. Th...
- RARC N11 - Denial reversed because of medical review.
- RARC N13 - Payment based on professional/technical component modifier(s).
- RARC N14 - Payment based on a contractual amount or agreement, fee schedule, or...
- RARC N31 - Missing/incomplete/invalid prescribing provider identifier.
- RARC M1 - X-ray not taken within the past 12 months or near enough to the start...
- RARC M3 - Equipment is the same or similar to equipment already being used.
- RARC M7 - No rental payments after the item is purchased, or after the total of...
- RARC M9 - This is the tenth rental month. You must offer the option of changing...
- RARC M23 - Missing invoice.
- RARC M27 - The patient has been relieved of liability of payment of these items...
- RARC M36 - This is the 11th rental month. You must offer the patient the option...
- RARC M39 - The patient is not liable for payment for this service as the advance...
- RARC M44 - Missing/incomplete/invalid condition code.
- RARC M55 - We do not pay for self-administered anti-emetic drugs.
- RARC M59 - Missing/incomplete/invalid 'from' date of service.
- RARC M64 - Missing/incomplete/invalid other diagnosis.
- RARC M66 - Our records indicate that we should be the third payer for this claim...
- RARC M69 - Paid at the regular rate as you did not submit documentation to justi...
- RARC M70 - NDC code submitted for this service was translated to a HCPCS code fo...
- RARC M90 - Not covered more than once in a 12-month period.
- RARC M97 - Not paid to practitioner when provided to patient in this place of se...
- RARC M102 - Service not performed on equipment approved by the FDA for this purpose.
- RARC M117 - Not covered unless submitted via electronic claim.
- RARC M124 - Missing indication of whether the patient owns the equipment that req...
- RARC N7 - Processing of this claim/service has included consideration under Maj...
- RARC N12 - Policy provides coverage supplemental to Medicare. As the member does...
- RARC N21 - Alert: Your line item has been separated into multiple lines to exped...
- RARC N25 - This company has been contracted by your benefit plan to provide admi...
- RARC N27 - Missing/incomplete/invalid treatment number.
- RARC N32 - Claim must be submitted by the provider who rendered the service.
- RARC N36 - Claim must meet primary payer's processing requirements before we can...
- RARC N40 - Missing radiology film(s)/image(s).
- RARC N44 - Payer's Reasonable & Customary fees lower than provider's submitted c...
- RARC N46 - Missing/incomplete/invalid admission hour.
- RARC N50 - Missing/incomplete/invalid discharge information.
- RARC N55 - Procedures for billing with group/referring/performing providers were...
- RARC N64 - The 'from' and 'to' dates must be different.
- RARC N67 - Professional provider services not paid separately. Included in facil...
- RARC N70 - Consolidated billing and payment applies.
- RARC N77 - Missing/incomplete/invalid designated provider number.
- RARC N82 - Providers who administer vaccines are encouraged to bill separately.
- RARC N85 - Requested additional information was not received.
- RARC N88 - Alert: This payment is being made conditionally. An HHA episode of ca...
- RARC N97 - Patients with stress incontinence, urinary obstruction, and specific...
- RARC N102 - This claim has been denied without reviewing the medical record becau...
- RARC N106 - Payment for services furnished to Skilled Nursing Facility (SNF) inpa...
- RARC N109 - This claim/service was chosen for complex review and was denied after...
- RARC N112 - This claim is excluded from your electronic remittance advice.
- RARC N118 - This service is not paid if billed more than once every 28 days.
- RARC N127 - This is a misdirected claim/service for an RRB beneficiary. Submit pa...
- RARC N131 - Total payments under multiple contracts cannot exceed the allowance f...
- RARC N146 - Missing screening document.
- RARC N160 - The patient must choose an option before a payment can be made for th...
- RARC N173 - No qualifying hospital stay dates were provided for this episode of c...
- RARC N176 - Services provided aboard a ship are covered only when the ship is of...
- RARC N180 - This item or service does not meet the criteria for the category unde...
- RARC N185 - Alert: Do not resubmit this claim/service.
- RARC N192 - Patient is a Medicaid/Qualified Medicare Beneficiary.
- RARC N200 - The professional component must be billed separately.
- RARC N225 - Incomplete/invalid documentation/orders/notes/summary/report/chart.
- RARC N234 - Incomplete/invalid oxygen certification/re-certification.
- RARC N260 - Missing/incomplete/invalid billing provider/supplier contact informat...
- RARC N272 - Missing/incomplete/invalid other payer attending provider identifier.
- RARC N291 - Missing/incomplete/invalid rendering provider primary identifier.
- RARC N300 - Missing/incomplete/invalid occurrence date(s).
- RARC N318 - Missing/incomplete/invalid discharge or end of care date.
- RARC N336 - Missing/incomplete/invalid referral date.
- RARC N350 - Missing/incomplete/invalid description of service for a Not Otherwise...
- RARC N370 - Billing exceeds the rental months covered/approved by the payer.
- RARC N380 - The original claim has been processed, submit a corrected claim.
- RARC N390 - This service/report cannot be billed separately.
- RARC N400 - Alert: Electronically enabled providers should submit claims electron...
- RARC N410 - Not covered unless the prescription changes.
- RARC N428 - Not covered when performed in this place of service.
- RARC N455 - Missing Physician Order.
- RARC N466 - Missing Physical Therapy Notes/Report.
- RARC N479 - Missing Explanation of Benefits (Coordination of Benefits or Medicare...
- RARC N505 - This facility is not authorized for this procedure.
- RARC N517 - Resubmit a new claim with the requested information.
- RARC N540 - Payment adjusted based on the interrupted stay policy.
- RARC N565 - Alert: This non-payable code is for required reporting only.
- RARC N575 - Mismatch between the submitted provider information and the provider...
- RARC N600 - Adjusted because services may be related to a hospital admission.
- RARC N620 - This payer does not cover items and services furnished to an individu...
- RARC N630 - Referral not authorized by attending physician.
- RARC N640 - Exceeds number/frequency approved/allowed within time period.
- RARC N657 - This should be billed with the appropriate code for these services.
- RARC N674 - Not covered unless a pre-requisite procedure/service has been provided.
- RARC N700 - Payment adjusted based on the Electronic Health Records (EHR) Incenti...
- RARC N750 - Missing/incomplete/invalid Social Security Number or Health Insurance...
- RARC N788 - Alert: Patient was transferred. Medicare Advantage plan (Part C) or P...
- RARC N800 - Only one evaluation and management code at this service level is cove...
- RARC N9 - Adjustment represents the estimated amount a previous payer may pay.
- RARC N15 - Services for a newborn must be billed separately.
- RARC N37 - Missing/incomplete/invalid tooth number/letter.
- RARC N61 - Rebill services on separate claims.
- RARC N90 - Covered only when performed by the attending physician.
- RARC N117 - This service is paid only once in a patient's lifetime.
- RARC N128 - This amount represents the prior to coverage portion of the allowance.
- RARC N170 - A new/revised/renewed certificate of medical necessity is needed.
- RARC N210 - Alert: You may appeal this decision.
- RARC N287 - Missing/incomplete/invalid referring provider primary identifier.
- RARC N309 - Missing/incomplete/invalid assessment date.
- RARC N420 - Not covered when considered routine.
Glossary
- Glossary
- 21st Century Cures Act
- 277CA (Claim Acknowledgment)
- 340B Drug Pricing Program
- 835 File (Electronic Remittance Advice)
- 837 File (Healthcare Claim)
- ABN Form (CMS-R-131)
- ACA Marketplace
- Accountable Care Organization
- Accounts Receivable Aging Report
- Accounts Receivable Days
- ACO Benchmark
- ACO REACH
- Add-On Code
- Additional Development Request (ADR)
- Advance Beneficiary Notice
- Advanced Alternative Payment Model (Advanced APM)
- Agentic AI in Revenue Cycle Management
- AI Denial Prediction
- AI Governance in Healthcare
- AI Medical Scribe
- ALJ Hearing (Medicare Level 3 Appeal)
- Allowed Amount
- Alternative Payment Model (APM)
- Ambient Clinical Documentation
- Ambulatory Payment Classification (APC)
- Ambulatory Surgery Center (ASC)
- Anti-Kickback Statute
- Appeal Success Rate
- AR Aging
- Attribution Methodology
- Authorization Denial
- Autonomous Coding
- Bad Debt
- Balance Billing
- Behavioral Health Integration (BHI)
- Benchmark Population
- Blended National Average Risk Score
- Bundled Payment
- Bundled Payments for Care Improvement Advanced (BPCI-A)
- CAHPS (Consumer Assessment of Healthcare Providers and Systems)
- Capitation
- CAQH (Council for Affordable Quality Healthcare)
- CARC Code
- Carequality
- Case Mix Index (CMI)
- Cash Posting
- CDI Program
- CDI Query Process
- CDS Hooks
- Certified Risk Adjustment Coder (CRC)
- Charge Capture
- Charge Entry
- Charge Lag
- Chargemaster
- Charity Care
- Chart Chase
- Children's Health Insurance Program (CHIP)
- Chronic Care Management
- Claim Appeal
- Claim Denial
- Claim Edit Engine
- Claim Follow-Up
- Claim Rejection
- Claim Scrubber
- Claim Triage AI
- Clean Claim Rate
- Clearinghouse
- Clearinghouse in Medical Billing
- Clearinghouse Rejection vs Payer Denial
- Clinical AI Bias
- Clinical AI Model Validation
- Clinical Denial
- Clinical Documentation Improvement
- Clinically Integrated Network (CIN)
- CMS Star Ratings
- CMS-1500 Form
- CMS-HCC V24 Risk Adjustment Model
- CMS-HCC V28 Risk Adjustment Model
- CMS-HCC V28 Transition Schedule
- COBRA Insurance
- Coding Compliance
- Coding Gap Analysis
- Coding Intensity Factor
- Coinsurance
- CommonWell Health Alliance
- Companion Guide (EDI)
- Computer-Assisted Coding (CAC)
- Computer-Assisted Physician Documentation (CAPD)
- Concurrent Risk Adjustment
- Condition Category
- Consolidated Clinical Document Architecture (C-CDA)
- Consultation Note
- Contractual Adjustment
- Conversion Factor (Medicare)
- Coordination of Benefits
- Copay
- Cost to Collect
- CPT Code (Current Procedural Terminology)
- Credit Balance
- Da Vinci Coverage Requirements Discovery (CRD)
- Da Vinci Documentation Templates and Rules (DTR)
- Da Vinci Payer Data Exchange (PDex)
- Da Vinci Prior Authorization Support (PAS)
- Days in Accounts Receivable
- De-identification (HIPAA)
- Deductible
- Denial Management
- Denial Prevention
- Denial Rate
- Denial Reason Code
- Denial Root Cause Analysis
- Denial Work Queue
- Diagnosis-Related Group (DRG)
- Direct Contracting Entity (DCE)
- Direct Secure Messaging
- Discharge Summary
- Downcoding
- Downside Risk
- E/M Leveling
- EDI Clearinghouse
- EDI Transaction
- EDIFACT
- EHR Copilot
- EHR Integration
- Electronic Clinical Quality Measure (eCQM)
- Electronic Prescribing of Controlled Substances (EPCS)
- Electronic Remittance Advice
- Electronic Remittance Advice (835)
- Eligibility Verification
- Encounter Data Processing System (EDPS)
- Encounter Data Submission
- EOB (Explanation of Benefits)
- Evaluation and Management (E&M) Coding
- Exclusive Provider Organization (EPO)
- Explainable AI in Healthcare (XAI)
- Explanation of Benefits
- False Claims Act
- FDA Software as a Medical Device (SaMD)
- Fee Schedule
- Fee-for-Service
- FHIR API
- FHIR Bulk Data Access
- FHIR Bundle
- FHIR Consent Resource
- FHIR Questionnaire Resource
- FHIR R4 (Release 4)
- FHIR Resource
- FHIR Subscription
- Financial Assistance Policy
- First-Pass Resolution Rate
- Flat FHIR (Bulk Data Export)
- Flexible Spending Account (FSA)
- Formulary
- Generative AI Medical Coding
- Global Budget Payment
- Global Surgical Package
- Global Surgical Period
- Good Faith Estimate
- Gross Collection Rate
- GS Segment (Functional Group Header)
- Hallucination Risk (AI)
- Hard Denial
- HCAHPS (Hospital CAHPS)
- HCC Capture Rate
- HCC Coding Accuracy
- HCC Gap Closure
- HCC Recapture
- HCPCS Code
- Health Maintenance Organization (HMO)
- Health Savings Account (HSA)
- Healthcare Clearinghouse under HIPAA
- HEDIS (Healthcare Effectiveness Data and Information Set)
- HHS-HCC Commercial Risk Adjustment Model
- Hierarchical Condition Category
- High Deductible Health Plan
- HIPAA Compliance
- HIPAA Safe Harbor De-identification
- History and Physical
- HITRUST CSF Certification
- HL7 Interface
- HL7 v2 vs FHIR
- Hospital Price Transparency
- Hospital-Acquired Condition (HAC)
- ICD-10 Code
- ICD-10-PCS
- In-Home Assessment (Risk Adjustment)
- In-Network
- Incident To Billing
- Information Blocking
- Inpatient Prospective Payment System (IPPS)
- Insurance Verification
- Intelligent Document Processing (IDP)
- ISA Segment (Interchange Control Header)
- J-Code (HCPCS Level II Drug Code)
- Kidney Care Choices (KCC) Model
- Large Language Models in Healthcare
- Length of Stay (LOS)
- Letter of Medical Necessity (LMN)
- Local Coverage Determination (LCD)
- Loop 2300 (Claim Information) in 837
- Making Care Primary (MCP) Model
- MEAT Criteria
- Medicaid Managed Care
- Medical Claims Clearinghouse
- Medical Coding Audit
- Medical Decision Making (MDM)
- Medical Loss Ratio (MLR)
- Medical Necessity
- Medical Necessity Denial
- Medical Record Retrieval (Risk Adjustment)
- Medically Unlikely Edits (MUE)
- Medicare Access and CHIP Reauthorization Act
- Medicare Administrative Contractor (MAC)
- Medicare Advantage
- Medicare Advantage Benchmark
- Medicare Appeals Council (Level 4 Appeal)
- Medicare Cost Report
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare Physician Fee Schedule (MPFS)
- Medicare Redetermination
- Medicare Secondary Payer
- Medicare Shared Savings Program (MSSP)
- Medigap (Medicare Supplement Insurance)
- Merit-based Incentive Payment System
- Minimum Savings Rate (MSR)
- Modifier 22 (Increased Procedural Services)
- Modifier 24 (Unrelated E/M in Postoperative Period)
- Modifier 25
- Modifier 26 — Professional Component
- Modifier 33 (Preventive Services)
- Modifier 50 (Bilateral Procedure)
- Modifier 51 — Multiple Procedures
- Modifier 52 (Reduced Services)
- Modifier 53 (Discontinued Procedure)
- Modifier 57 — Decision for Surgery
- Modifier 58 (Staged or Related Procedure)
- Modifier 59
- Modifier 62 (Two Surgeons)
- Modifier 66 (Surgical Team)
- Modifier 76 — Repeat Procedure by Same Physician
- Modifier 78 (Unplanned Return to OR During Global Period)
- Modifier 79 (Unrelated Procedure During Global Period)
- Modifier 80 (Assistant Surgeon)
- Modifier 91 (Repeat Clinical Diagnostic Laboratory Test)
- Modifier AT (Active Treatment for Chiropractic)
- Modifier CS (Cost-Sharing Waived for COVID-19 Testing)
- Modifier GA (Waiver of Liability Statement on File)
- Modifier GY (Statutorily Excluded)
- Modifier GZ (Item or Service Expected to Be Denied)
- Modifier KX (Requirements Specified in Medical Policy Met)
- Modifier TC (Technical Component)
- Modifier XE (Separate Encounter)
- Modifier XS (Separate Structure)
- Modifier XU (Unusual Non-Overlapping Service)
- Modifiers LT and RT (Left/Right Side)
- MS-DRG (Medicare Severity Diagnosis-Related Group)
- Multiple Procedure Payment Reduction (MPPR)
- National Coverage Determination (NCD)
- National Drug Code (NDC)
- National Provider Identifier (NPI)
- NCCI Edits
- NCQA Accreditation
- Net Collection Rate
- Network Adequacy
- Never Event
- NLP in Healthcare
- No Surprises Act
- Normalization Factor
- OAuth Scopes (SMART on FHIR)
- OCR in Healthcare (Optical Character Recognition)
- OIG Exclusion
- Oncology Care Model (OCM) / Enhancing Oncology Model (EOM)
- Operative Report
- Out-of-Network
- Outpatient Prospective Payment System (OPPS)
- Overpayment
- Patient Access
- Patient Access API
- Patient Estimation
- Patient Financial Experience
- Patient Registration
- Patient-Centered Medical Home (PCMH)
- Payer Mix
- Payer Scorecard
- Payer-to-Payer API
- Payment Integrity
- PECOS (Provider Enrollment, Chain, and Ownership System)
- PEPPER Report
- Per Member Per Month (PMPM)
- Pharmacy Benefit Manager (PBM)
- Physician Signature Requirements
- Place of Service (POS) Code
- Point of Service (POS) Plan
- Point-of-Service (POS) Collections
- Policyholder
- Population Health Management (PHM)
- Practice Management System
- Pre-Claim Edit
- Predetermination
- Preferred Provider Organization (PPO)
- Present on Admission (POA Indicator)
- Primary Care First (PCF)
- Prior Authorization
- Prior Authorization API
- Prior Authorization Automation
- Problem List Management
- Procedure-to-Procedure (PTP) Edit
- Professional Component (Modifier 26)
- Program Integrity
- Progress Note
- Prompt Injection
- Propensity to Pay
- Prospective Risk Adjustment
- Protected Health Information (PHI)
- Provider Credentialing
- Provider Directory API
- QIC Reconsideration (Level 2 Medicare Appeal)
- Qualified Health Information Network (QHIN)
- Qualifying APM Participant (QP)
- Quality Payment Program (QPP)
- Quality Withhold
- RCM Software
- Readmission Rate
- Recovery Audit Contractor
- Relative Value Unit (RVU)
- Remark Code (RARC)
- Remittance Advice
- Remote Patient Monitoring
- Resource-Based Relative Value Scale (RBRVS)
- Retrieval-Augmented Generation (RAG)
- Retrospective Risk Adjustment
- Revenue Code (UB-04 Form Locator 42)
- Revenue Cycle Automation
- Risk Adjustment
- Risk Adjustment Audit Rate
- Risk Adjustment Data Validation (RADV) Audit
- Risk Adjustment Factor (RAF) Score
- Risk Score Reconciliation
- Robotic Process Automation (RPA)
- RxHCC (Prescription Drug Hierarchical Condition Category)
- Secondary Insurance
- Self Pay
- Service Line Reporting
- Shared Savings
- Single Case Agreement (SCA)
- SMART on FHIR
- SOAP Note
- SOC 2 Type II Report
- Social Determinants of Health (SDOH)
- Soft Denial
- Split Billing (Professional/Technical)
- Split/Shared Visit
- Stark Law
- Stars Bonus Payment (Quality Bonus Payment)
- States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
- Step Therapy
- Subrogation
- Subscriber ID
- Surescripts
- Suspect Condition
- Targeted Probe and Educate (TPE)
- Taxonomy Code
- Teaching Physician Rules
- Technical Denial
- TEFCA (Trusted Exchange Framework and Common Agreement)
- Telehealth Billing
- The Joint Commission
- Third-Party Liability (TPL)
- Time-Based E/M Coding
- Timely Filing
- Timely Filing Denial
- Total Cost of Care (TCOC)
- Transitional Care Management (TCM)
- TRICARE Billing
- Two-Sided Risk
- Type of Bill (UB-04 Form Locator 04)
- UB-04 (Institutional Claim Form)
- UB-04 Condition Code (Form Locators 18–28)
- UB-04 Occurrence Code (Form Locators 31–34)
- UB-04 Value Code (Form Locators 39–41)
- Unbundling
- Uncompensated Care
- Underpayment
- Upcoding
- Upside-Only Risk
- US Core FHIR Implementation Guide
- USCDI (United States Core Data for Interoperability)
- Utilization Management
- Utilization Review
- Value-Based Care
- Voice AI Documentation
- Workers' Compensation Billing
- Write-Off
- X12 270 (Eligibility Inquiry)
- X12 271 (Eligibility Response)
- X12 276 (Claim Status Inquiry)
- X12 277 (Claim Status Response)
- X12 278 (Prior Authorization Request/Response)
- X12 820 (Premium Payment)
- X12 834 (Benefit Enrollment and Maintenance)
- X12 999 (Implementation Acknowledgement)
- X12 TA1 (Interchange Acknowledgement)
- Zero Balance Review
Alternatives
- Athelas (Commure) Alternatives
- athenahealth Alternatives
- Availity Clearinghouse Alternatives
- CareCloud Alternatives
- Change Healthcare Clearinghouse (Optum) Alternatives
- CharmHealth Alternatives
- Claim.MD Alternatives
- CureMD Alternatives
- Emdeon Clearinghouse Alternatives
- Ensemble Health Partners Alternatives
- Epic Systems Alternatives
- Fathom Health Alternatives
- Freed.ai Alternatives
- Guidehouse Alternatives
- Innovaccer Alternatives
- Office Ally Clearinghouse Alternatives
- Optum (Optum Insight) Alternatives
- R1 RCM Alternatives
- Stedi Clearinghouse Alternatives
- Sully.ai Alternatives
- Waystar Alternatives