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New Claim Adjustment Reason Codes (CARCs) Added to TexMedConnect

Date: June 10, 2025

Attention: All Providers

Effective Date: June 6, 2025

Call to action: On June 6, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) added 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 can now 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 added 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 updated 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

Next steps: Providers are encouraged to share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.