CARC 118: ESRD Network Support Adjustment

What it means

This adjustment applies to claims for patients with End-Stage Renal Disease (ESRD). It reflects a reduction or change tied to funding that supports the ESRD Network program, which oversees quality and care coordination for dialysis and renal patients. It is a program-level adjustment rather than a sign that something was done incorrectly on the claim.

Common causes

Claim is for ESRD-related services (dialysis, renal care) subject to network support funding adjustments
Standard payer application of the ESRD Network assessment built into reimbursement calculations
Facility or provider is part of the ESRD Prospective Payment System (PPS) that includes this adjustment

How to fix it

Confirm the adjustment amount aligns with expected ESRD PPS calculations for the billing period
Cross-check against your ESRD facility's payment rate documentation from CMS or the payer
Verify this is not paired with an unrelated denial reason that also needs correction
If the amount seems inconsistent with prior claims, contact the payer's provider services line to confirm the adjustment logic
No resubmission is typically needed unless the adjustment appears in error compared to your ESRD PPS rate sheet

Appeal / resubmit

Because this is a structural funding adjustment tied to the ESRD PPS rather than a coding or documentation issue, appeals are uncommon. If you believe the adjustment amount is miscalculated, request a detailed remittance breakdown from the payer and compare it to your current ESRD PPS base rate and applicable adjustments before deciding whether to dispute.

Related codes

Frequently asked

Does CARC 118 mean my claim was denied?

Not necessarily. It usually indicates an adjustment amount tied to ESRD Network program funding rather than a full denial of the claim.

Do I need to correct and resubmit the claim?

Generally no, unless you find the adjustment amount doesn't match your expected ESRD PPS calculation. Review your rate documentation first.

Who can explain how this adjustment is calculated?

The payer's provider services department or CMS ESRD PPS resources can clarify how the network support adjustment factors into your specific payment.

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This content is informational only and is not billing or legal advice. Verify all claim-specific details with the payer or a qualified billing professional.