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New CARCs to Be Added to TexMedConnect on June 6, 2025

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On June 6, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will add new Claim Adjustment Reason Codes (CARCs) to TexMedConnect. The new codes apply to Texas Medicaid, based on a list of CARCs that are compliant with the Health Insurance Portability and Accountability Act (HIPAA).

Providers will see new CARCs added under the Adjustment Reason Code drop-down menu, which is located in the “Disposition” section in TexMedConnect.

This change allows TMHP to process claims with other insurance information (based on their claim adjustment reason codes) in TexMedConnect. The other insurance disposition is determined by how many other insurance instances are submitted in the Electronic Data Interchange (EDI) 837 claim transaction.

New CARC Codes

TMHP will add the following CARC codes:

  • 303—Prior payer's patient responsibility not covered for qualified Medicare and Medicaid beneficiaries.
  • 304—Benefits not available under this plan. Submit these services to the patient's hearing plan for further consideration.
  • 305—Benefits not available under this plan, and the claim has been forwarded to the patient's hearing plan for further consideration.
  • 306—Type of bill is inconsistent with the patient status.
  • P32—Payment adjusted due to apportionment.

Note: TMHP will deny claims that are submitted to Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program that include both other insurance information and a CARC that indicates that the provider did not bill the other insurance correctly. Providers must identify and correct any billing errors in claims that they submitted to primary payers before they submit the claims to Texas Medicaid for payment consideration.

EDI Companion Guides

TMHP will update the following EDI Companion Guides to align with these changes:

  • 837D Acute Care Companion Guide
  • 837I Acute Care Companion Guide
  • 837P Acute Care Companion Guide

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.