HomeDenial Codes

Claim Adjustment Reason Codes (CARC)

297 active denial codes — each page explains the denial in plain English: why it happened, whether the patient can be billed, and how to fix and resubmit.

1Deductible Handling Tips 2Coinsurance Amount Explained 3Co-payment Amount: Next Steps 4Fix Modifier/Procedure Errors 5Fix Inconsistent Place of Service 6Fix Age-Related Coding Errors 7Fix Gender Mismatch Issues 8Fix Provider Type/Specialty Mismatch 9Fix Age-Diagnosis Mismatch 10Diagnosis vs Gender Mismatch 11Diagnosis Inconsistent with Procedure 12Fix Provider Type Mismatch 13Fix Date of Death Errors 14Date of Birth Error Fixes 16Fix Claim Submission Errors 18Duplicate Claim Resolution 19Worker's Comp Liability - Fix & Prevent 20Liability Carrier Coverage Explained 21No-Fault Carrier Liability 22Coordination of Benefits Fix 23Prior Payer Adjustment Impact 24Capitation Agreement Info & Fixes 26Expenses Prior to Coverage 27Coverage Termination Fix Steps 29Filing Time Limit Expired 31Fix Patient ID Issues 32Eligibility and Resolution Steps 33Insured Has No Dependent Coverage 34No Coverage for Newborns Explained 35Lifetime Benefit Max Reached 39Understand & Resolve 40Emergent Care Qualifications 44Prompt-Pay Discount Explained 45Exceeds Fee Schedule Fixes 49Routine Service Non-Covered 50Medical Necessity Tips & Fixes 51Non-Covered Pre-Existing Condition 53Services by Relative Not Covered 54Fix Multiple Physicians Issue 55Experimental Treatment Solutions 56Procedure Not Proven Effective 58Invalid Place of Service Fixes 59Multiple Procedure Adjustment 60Outpatient Services Coverage Fix 61Fix Missing Second Surgical Opinion 66Blood Deductible Solutions 69Fix Day Outlier Amount Issues 70Understanding & Resolving Adjustments 74Indirect Medical Education Adjustment 75Direct Medical Education Adjustment 76Disproportionate Share Adjustment 78Resolve Non-Covered Days 85Patient Interest Adjustment Guide 89Professional Fees Adjustment 90Ingredient Cost Adjustment Fix 91Fix Dispensing Fee Adjustments 94Resolve Excess Charge Issues 95Resolve Plan Procedures Issue 96Non-covered Charges Explained 97Bundle Payment Explained 100Payment to Patient Explained 101Predetermination Fix & Appeal Guide 102Major Medical Adjustment Fix 103Provider Discount Applied 104Managed Care Withholding Fix 105Tax Withholding Adjustment 106Patient Payment Option Issues 107Resolve and Prevent Issues 108Rent/Purchase Guidelines - Fix & Appeal 109Not Covered by This Payer 110Fix Billing Date Errors 111Resolve & Prevent Assignment Issues 112Service Not Furnished Directly 114FDA Approval Issues & Fixes 115Procedure Postponed or Canceled 116Fix Advance Notice Compliance 117Transport to Closest Facility 118ESRD Network Adjustment Explained 119Max Benefit Reached - Fix & Appeal 121Indemnification Adjustment Explained 122Fix Psychiatric Reductions 128Newborn Services Covered 129Fix & Prevent Processing Errors 130Claim Submission Fee Guide 131Understand & Resolve Adjustments 132Understanding & Resolving Adjustments 133Pending Review Solutions 134Technical Fees Removed Guide 135Interim Bills Fix & Prevention 136Fix Prior Payer Rule Issues 137Regulatory Surcharge Fixes 139Contractual Funding Fixes 140Fix Patient ID Mismatches 142Medicaid Patient Liability 143Resolve Deferred Payments 144Understanding Incentive Adjustments 146Diagnosis Invalid for Service Date 147Contract Rate Expired Solution 148Missing Provider Information 149Lifetime Max Reached - Fix Tips 150Unsupported Service Level Fix 151Frequency of Services Issue 152Fix Length of Service Issues 153Dosage Documentation Issues 154Supply Limit Solutions 155Patient Refused Service 157Act of War Services 158Fix & Appeal Steps 159Terrorism Service Adjustment 160Benefit Exclusion Explained 161Provider Performance Bonus 163Fix Missing Documentation 164Missing Documentation Fixes 166Resolve & Prevent 167Diagnosis Not Covered 169Alternate Benefit Provided 170Provider Type Mismatch Fixes 171Provider/Facility Mismatch 172Resolve Provider Specialty Issues 173Fix Missing Physician Order 174Fix Missing Prescription Issues 175Fix Incomplete Prescription Issues 176Prescription Not Current 177Eligibility Requirements Unmet 178Patient Spend Down Unmet 179Resolve Waiting Period Issues 180Resolve Residency Requirement Issues 181Fix Invalid Procedure Code 182Fix Invalid Modifier Issues 183Fix Referring Provider Issues 184Fix Provider Eligibility Issues 185Provider Eligibility Fix 186Level of Care Adjustment Fix 187Consumer Spending Account Guide 188FDA Recommendation Compliance 189Fix Unlisted Procedure Code 190SNF Payment Inclusion 192Resolve Non-Standard Adjustments 193Original Payment Decision Maintained 194Fix & Prevent Anesthesia Billing Issues 195Refund to Erroneous Payer Fix 197Fix Missing Preauthorization 198Fix Precertification Issues 199Fix Revenue & Procedure Mismatch 200Coverage Lapse Expenses 201Patient-Billed Agreement 202Fix Non-Covered Services 203Discontinued Service Fixes 204Coverage Fixes & Appeals 205Pharmacy Discount Fee Guide 206Fix Missing NPI Errors 207Fix Invalid NPI Format Errors 208NPI Mismatch Fix & Prevention 209Understand & Resolve Adjustments 210Pre-certification Not Timely 211Fix & Prevent NDC Rebate Issues 212Fix Admin Surcharge Issues 213Fix Self-Referral Issues 215Subrogation Settlement Explained 216Review Findings Impact Payment 219Fix Extent of Injury Issues 222Fix & Prevent Contractual Unit Errors 223Understand & Address Adjustments 224Identity Theft Resolution 225Understand & Resolve Penalty Payments 226Info Request Fix & Prevention 227Resolve Patient Info Issues 228Resolve Missing Info Issues 229Medicare Bypass Fixes 231Fix Mutually Exclusive Procedures 232Fix DRG Transfer Adjustments 233Hospital-Acquired Condition Fix 234Procedure Not Paid Separately 235Sales Tax Adjustment Tips 236Fix Incompatible Procedure Issues 237Fix Legislated Penalties 238Coverage Period Adjustment 239Split Claims for Coverage Issues 240Diagnosis vs. Birth Weight Fix 241Fix Low Income Subsidy Issues 242Network Provider Issues 243Services Not Authorized - Fix Tips 245Understand and Fix Provider Withhold 246Reporting Only: No Action Needed 247Patient Deductible Details 248Coinsurance Fix Steps 249Readmission Claim Denial Explained 250Fix Missing Documentation 251Fix Incomplete Documentation 252Fix Missing Documentation 253Sequestration Adjustment Help 254Dental Plan Claim Issue 256Managed Care Contract Issues 257Grace Period Claim Hold 258Custody/Incarceration Coverage 259Dental/Vision Payment Adjustment 260Medicaid ACA Fee Adjustment 261Fix Inconsistent History 262Fix Delivery Cost Adjustments 263Fix & Prevent Shipping Cost Issues 264Understanding & Resolving 265Understand and Resolve Adjustments 266Compound Preparation Cost Adjustment 267Resolve Multi-Month Claim Issues 268Fix Year-Span Claims 269Anesthesia Not Covered 270Resolve with Dental Plan 271Understand & Resolve Adjustments 272Coverage Guidelines Unmet 273Coverage Guidelines Exceeded 274Care Coordination Fee Issue 275Resolve Patient Responsibility Issues 276Fix & Appeal Steps 277Resolve SHOP Grace Period Holds 278Resolve & Prevent Adjustments 279Out-of-Network Provider Fixes 280Fix Claim Submission Errors 281Deductible Waived, Next Steps 282Fix Inconsistent Bill Types 283Ineligible Provider Direction 284Fix Precertification Issues 285Appeal Steps Not Followed 286Appeal Time Limit Exceeded 287Referral Exceeded Solutions 288Referral Absent: Fix & Appeal Steps 289Dental/Medical Plan Benefits Not Available 290Forwarded to Medical Plan 291Forwarded to Dental Plan 292Benefits Not Available Fix Steps 293Payment Made to Employer 294Payment to Attorney Explained 295Understand and Resolve DIR Adjustments 296Fix & Prevent Authorization Errors 297Vision Plan Submission Fix 298Vision Plan Forwarding 299Fix Provider Eligibility Issues 300Fix Behavioral Health Claims 301Benefits Not Available - Fix Tips 302Fix Expired Authorization Issues 303Patient Responsibility Explained 304Benefits Not Available, Next Steps 305Claim Forwarded to Hearing Plan 306Fix Inconsistent Bill Type 307Medicare Price Adjustment Guide 308Contracted Funding Adjustment A0Patient Refund Steps A1Fix & Appeal Steps A5Medicare Outlier Adjustment Fix A6Fix Prior Hospitalization Errors A8Fix Ungroupable DRG Issues B1Non-covered Visits, Fix & Appeal Steps B4Late Filing Penalty Solutions B7Fix Provider Eligibility Issues B8Alternative Services Issue B9Hospice Enrollment Issue B10Resolve Reduced Allowed Amount B11Claim Transferred, What to Do B12Fix Missing Documentation B13Resolve Payment Duplication Issues B14Understanding & Resolving B15Qualifying Service Required B16Fix 'New Patient' Errors B20Fix Overlapping Service Issues B22Diagnosis-Based Adjustment B23Fix Unauthorized Procedure P1State Mandate Fix & Prevention P2Workers' Comp Liability Guide P3Understanding Patient Liability P4Workers' Comp Non-Compensable Fixes P5Understand and Address Fee Adjustments P6Entitlement to Benefits Fix Guide P7Resolve Fee Schedule Errors P8Claim Under Investigation P9Resolve Missing CPT/HCPCS Issues P10Zero Payment Due to Litigation P11Pending Litigation Resolution P12Workers' Comp Fee Schedule Fix P13Workers' Comp Jurisdiction Adjustment P14Fix Bundled Service Denials P15Workers' Comp Adjustment Fixes P16Resolve Unauthorized Provider Issues P17Fix Referral Authorization Issues P18Procedure Not in Fee Schedule P19Zero Value Procedure Fix Tips P20Fix & Prevent Outpatient Facility Errors P21Fix & Appeal Steps for Billers P22Understand & Resolve Payment Adjustments P23Fix Fee Schedule Adjustments P24PPO Adjustment Remedies P25MPN Adjustment Solutions P26Understand & Address Adjustments P27Fix Auto Liability Payment Issues P28Fix Liability Coverage Adjustments P29Fix Jurisdictional Fee Adjustments P30Resolve & Prevent Payment Issues P31Exacerbation Time Limit Exceeded P32Understand and Address Payment Adjustments

Deactivated denial codes (110)