Submitting Claims When Health Choice Utah Is the Secondary Payer

When Health Choice Utah is the secondary payer, providers must ensure that claims are submitted with complete and accurate information to avoid processing delays or denials.

TO SUPPORT PROPER ADJUDICATION:

• Claims must include both the Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) for all charge lines, when applicable.
• Claims that are missing RARC codes will be denied with Claim Level Remark Code N4 – Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.

IF YOUR CLAIM IS DENIED WITH N4, YOU MUST SUBMIT A CORRECTED CLAIM THAT INCLUDES:

• The appropriate corrected claim indicator
• The original claim number
• The complete CARC and RARC codes from the primary insurance Explanation of Benefits (EOB)

Ensuring these elements are included helps prevent delays and supports accurate claims processing when Health Choice Utah is the secondary payer.