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Variable: ACO-RED-CARC

Pioneer Accountable Care Organization (ACO) Reduction CARC

Source System Definition

If the claim has a demonstration code equal to “59” (Pioneer ACO Demonstration) or “68” (Pioneer ACO SNF), and provided service is from an outpatient provider (TOB equal to 12, 13, 14, 22, 23, 34, 71, 72, 74, 75, 76, 77, 81, 82, 85) or the service is for home health Part B; this field will identify the applicable Claim Adjustment Reason Code (CARC) that defines why the service was paid differently than billed.

Other Info

  • Source System: FISS
  • Source Field: Pioneer Accountable Care Organization (ACO) Reduction CARC
  • Version: 0.12

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