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EDI Adjustment Code Customization

AngelTrack's EDI importer allows customization of RARC and CARC code interpretation.

You can configure AngelTrack's built-in lists of CARC (claim adjustment) and RARC (claim remark) codes in order to direct the EDI import process.

Each CARC and RARC can have any combination of these flags, which then appear within the various EOB import and display pages, and can even override aspects of the EDI importer.

Configuration

To configure AngelTrack's CARC and RARC interpretation, find the "Adjustment Codes" item on the Settings page.

You will see a grid of all defined RARCs (remark codes). Some of them will already have a flag or two set. You can customize the flags all you like. Then you can switch the grid to show the CARCs (adjustment codes) and do the same.

The flags you set will apply server-wide, affecting all users. That includes the automatic EDI importer, though your changes will not take effect for it until 03:00 CST the next morning.

Flag.small.yellow Yellow Flag: Documentation Problem

The yellow flag is set on all RARCs and CARCs that imply a problem with claim documentation. It does not alter the EOB import process; its only purpose is to visibly warn of a denial due to missing documentation.

Flag.small.orange Orange Flag: Treat as Appealable Denial

Any adjudication that has an RARC or CARC with the orange flag set will be imported as an appealable denial. Appealable denials, you will recall, move to the Insurance Appeal Queue.

If performing a manual EDI import, the orange flag will pre-set the "Import As" picklist to "Appealable Denial", which can be overridden by the biller before importing.

Flag.small.red Red Flag: Treat as Final Denial

Any adjudication that has an RARC or CARC with the red flag set will be imported as a final denial. Final denials, you will recall, move to invoicing.

If performing a manual EDI import, the red flag will pre-set the "Import As" picklist to "Final Denial", which can be overridden by the biller before importing.

Flag.small.green Green Flag: Treat as Approval

Any adjudication that has an RARC or CARC with the green flag set will be imported as an approval, even if it pays zero dollars which AngelTrack would otherwise treat as a quasi-denial.

If performing a manual EDI import, the green flag will pre-set the "Import As" picklist to "Approval", which can be overridden by the biller before importing.

Flag.small.blue Blue Flag: Heads Up

The blue flag does not alter the EOB import process; it simply provides a visual indication of a heads-up situation that needs to be reviewed.