Important Notice for Electronic Medicare Secondary Payer (MSP) Submitters
After a claim has been processed by the primary payer, you must include Claim Adjustment Reason Codes (CARC) when sending it to Medicare for processing. One very commonly used code is being deactivated as of June 1, 2007. Code 42: "Charges exceed our fee schedule or maximum allowable amount" will be deactivated on June 1, 2007. This has been replaced with code 45: "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement." Claims may be rejected if the codes you are submitting are not valid at the time the claim is submitted.
The CARC are updated three times a year, and are posted at http://wpc-edi.com/codes 
If you have any questions, please contact the EDI Hotline for IL/MI/WI (877) 567-7261. For Minnesota, please contact (952) 885-2882, (952) 885-2881or (952) 885-2811
Page Last Updated: Thursday, 18-Mar-2010 05:55:27 CDT
