CARC 157 Denial Code - Act of War Services
CARC 157 indicates that the service or procedure was provided as a result of an act of war. This means the payer is denying payment due to the specific circumstances under which the care was rendered, as they consider this situation outside the scope of standard coverage.
Who Pays: Group Code Liability
Code 157 is a benefit exclusion, and the remittance group code determines who absorbs it. PR-157 makes the excluded charges the patient’s responsibility and billable; CO-157 means a contract term requires the provider to write them off. Because war-related exclusions sometimes point to other coverage sources, such as government or military programs, check whether another payer applies before billing the patient.
Why Claims Get Code 157
- The patient received treatment in a conflict zone or during wartime.
- The patient's injury or condition was directly caused by military actions.
- Documentation explicitly mentioned the act of war as the reason for treatment.
- The payer's policy excludes coverage for acts of war.
- Incorrect coding or documentation implied a war-related cause.
How to Fix & Resubmit
- Verify the documentation to confirm if the service was indeed related to an act of war.
- Check the patient's insurance policy for any clauses about coverage during acts of war.
- Contact the payer to confirm their policy and the reason for applying CARC 157.
- If the service was incorrectly coded as war-related, correct the coding and resubmit the claim.
- If the payer policy allows, appeal the denial with evidence that the service should be covered.
Corrected Claim or Appeal?
Submit a corrected claim if the act of war is inaccurately documented. If the payer's policy allows for coverage of war-related services, file an appeal with supporting documentation. Otherwise, this is a contractual adjustment.
Preventing Future 157 Denials
- Ensure accurate documentation of the context in which services are provided.
- Review patient policies for exclusions related to acts of war before billing.
- Train staff on identifying and coding situations correctly to avoid unnecessary denials.
- Implement a review process for claims involving potentially war-related services.