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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.11 Remittance and Status (R&S) Report : 6.11.4 R&S Report Section Explanation : Explanation of Benefit Codes Messages
This section lists the descriptions of all EOBs that appeared on the R&S Report. EOBs appear in numerical order.
EDI ANSI X12 5010 835 files display the appropriate Claims Adjustment Reason Code (CARC), Claims Adjustment Group Code (CAGC), and Remittance Advice Remarks Code (RARC) explanation codes that are associated with EOB denials.
The 835 file includes the CARC, CAGC, and RARC explanation codes that are associated with the highest priority detail EOB to provide a clearer explanation for the denial.

Texas Medicaid & Healthcare Partnership
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