All CARC Denial Codes

281 active Claim Adjustment Reason Codes. Click any code to see causes, resolutions, and prevention tips.

Code	Name	Primary Group	Action
PR-1	Deductible Amount	PR	Collect from Patient	→
PR-2	Coinsurance Amount	PR	Collect from Patient	→
PR-3	Co-payment Amount	PR	Collect from Patient	→
CO-4	Procedure Code / Modifier Mismatch	CO	Resubmit	→
CO-5	Procedure Code Inconsistent with Place of Service	CO	Verify & Resubmit	→
CO-6	Procedure Inconsistent with Patient Age	CO	Verify & Resubmit	→
CO-7	Procedure Inconsistent with Patient Gender	CO	Verify & Resubmit	→
CO-8	Procedure Inconsistent with Provider Specialty	CO	Verify & Resubmit	→
CO-9	Diagnosis Inconsistent with Patient Age	CO	Verify & Resubmit	→
CO-10	Diagnosis Inconsistent with Patient Gender	CO	Verify & Resubmit	→
CO-11	Diagnosis Inconsistent with Procedure	CO	Verify & Resubmit	→
CO-12	Diagnosis Inconsistent with Provider Type	CO	Verify & Resubmit	→
CO-13	Date of Death Precedes Date of Service	CO	Verify & Resubmit	→
CO-14	Date of Birth Follows Date of Service	CO	Verify & Resubmit	→
CO-16	Missing Information or Billing Error	CO	Verify & Resubmit	→
CO-18	Exact Duplicate Claim or Service	CO	Verify & Resubmit	→
CO-19	Workers' Compensation Claim	CO	Verify & Resubmit	→
CO-20	Liability Carrier Responsible	CO	Verify & Resubmit	→
CO-21	No-Fault Carrier Responsible	CO	Verify & Resubmit	→
CO-22	Care Covered by Another Payer (COB)	CO	Verify & Resubmit	→
OA-23	Impact of Prior Payer Adjudication	OA	Review & Decide	→
CO-24	Charges Covered Under Capitation or Managed Care	CO	Review & Decide	→
CO-26	Expenses Incurred Prior to Coverage	CO	Verify & Resubmit	→
CO-27	Expenses Incurred After Coverage Terminated	CO	Verify & Resubmit	→
CO-29	Timely Filing Limit Expired	CO	Appeal	→
CO-31	Patient Not Identified as Insured	CO	Verify & Resubmit	→
CO-32	Patient Not Eligible as Dependent	CO	Verify & Resubmit	→
CO-33	Insured Has No Dependent Coverage	CO	Verify & Resubmit	→
CO-34	No Newborn Coverage	CO	Verify & Resubmit	→
CO-35	Lifetime Benefit Maximum Reached	CO	Review & Decide	→
CO-39	Services Denied at Pre-Certification	CO	Appeal	→
CO-40	Charges Not Qualifying as Emergent/Urgent Care	CO	Appeal	→
CO-44	Prompt-Pay Discount	CO	Review & Decide	→
CO-45	Charge Exceeds Fee Schedule / Maximum Allowable	CO	Review & Decide	→
CO-49	Routine/Preventive Exam Not Covered	CO	Verify & Resubmit	→
CO-50	Non-Covered Services / Medical Necessity Denial	CO	Appeal	→
CO-51	Pre-Existing Condition Exclusion	CO	Appeal	→
OA-53	Payment Adjusted Due to Prior Payer Adjudication	OA	Review & Decide	→
CO-54	Multiple Physicians/Assistants Not Covered	CO	Review & Decide	→
CO-55	Experimental / Investigational Procedure	CO	Appeal	→
CO-56	Procedure / Treatment Not Deemed Effective	CO	Appeal	→
CO-58	Invalid Place of Service / Treatment Setting Mismatch	CO	Resubmit	→
CO-59	Multiple / Concurrent Procedure Payment Reduction	CO	Review & Decide	→
CO-60	Outpatient Services Not Covered Near Inpatient Stay	CO	Review & Decide	→
CO-61	Second Surgical Opinion Not Obtained	CO	Verify & Resubmit	→
PR-66	Blood Deductible	PR	Collect from Patient	→
CO-69	Day Outlier Amount	CO	Review & Decide	→
CO-70	Cost Outlier Adjustment	CO	Review & Decide	→
CO-74	Indirect Medical Education Adjustment	CO	Review & Decide	→
CO-75	Direct Medical Education Adjustment	CO	Review & Decide	→
CO-76	Disproportionate Share Adjustment	CO	Review & Decide	→
CO-78	Non-Covered Days / Room Charge Adjustment	CO	Review & Decide	→
PR-85	Patient Interest Adjustment	PR	Collect from Patient	→
CO-89	Professional Fees Removed from Charges	CO	Verify & Resubmit	→
CO-90	Ingredient Cost Adjustment	CO	Verify & Resubmit	→
CO-91	Dispensing Fee Adjustment	CO	Review & Decide	→
CO-94	Processed in Excess of Charges	CO	Review & Decide	→
CO-95	Plan Procedures Not Followed	CO	Verify & Resubmit	→
CO-96	Non-Covered Charges	CO	Verify & Resubmit	→
CO-97	Bundled Service — Not Paid Separately	CO	Review & Decide	→
OA-100	Payment Made to Patient/Insured	OA	Collect from Patient	→
CO-101	Predetermination: Anticipated Payment	CO	Verify & Resubmit	→
CO-102	Major Medical Adjustment	CO	Review & Decide	→
CO-103	Provider Promotional Discount	CO	Review & Decide	→
CO-104	Managed Care Withhold	CO	Review & Decide	→
OA-105	Tax Withholding Amount	OA	Verify & Resubmit	→
CO-106	Patient Payment Option Not in Effect	CO	Verify & Resubmit	→
CO-107	Related or Qualifying Service Not Identified	CO	Resubmit	→
CO-108	Rent/Purchase Guidelines Not Met	CO	Verify & Resubmit	→
CO-109	Claim Not Covered by This Payer	CO	Verify & Resubmit	→
CO-110	Billing Date Predates Service Date	CO	Resubmit	→
CO-111	Not Covered Unless Provider Accepts Assignment	CO	Verify & Resubmit	→
CO-112	Service Not Furnished Directly or Not Documented	CO	Appeal	→
CO-114	Procedure/Product Not FDA Approved	CO	Appeal	→
CO-115	Procedure Postponed, Canceled, or Delayed	CO	Review & Decide	→
CO-116	Advance Indemnification Notice Requirements Not Met	CO	Review & Decide	→
CO-117	Transportation to Nearest Facility	CO	Appeal	→
CO-118	ESRD Network Support Adjustment	CO	Review & Decide	→
CO-119	Benefit Maximum Reached	CO	Review & Decide	→
OA-121	Indemnification Adjustment	OA	Review & Decide	→
CO-122	Psychiatric Services Reduction	CO	Review & Decide	→
CO-128	Newborn Services in Mother's Allowance	CO	Verify & Resubmit	→
CO-129	Prior Processing Information Incorrect	CO	Verify & Resubmit	→
CO-130	Claim Submission Fee	CO	Review & Decide	→
CO-131	Claim-Specific Negotiated Discount	CO	Review & Decide	→
CO-132	Prearranged Demonstration Project Adjustment	CO	Review & Decide	→
OA-133	Service Line Pending Further Review	OA	Review & Decide	→
CO-134	Technical Fees Removed	CO	Verify & Resubmit	→
CO-135	Interim Bills Cannot Be Processed	CO	Verify & Resubmit	→
OA-136	Failure to Follow Prior Payer's Coverage Rules	OA	Verify & Resubmit	→
OA-137	Regulatory Surcharges, Assessments, or Health-Related Taxes	OA	Verify & Resubmit	→
CO-139	Contracted Funding Agreement — Subscriber Employed by Provider	CO	Verify & Resubmit	→
CO-140	Patient ID Number and Name Do Not Match	CO	Resubmit	→
PR-142	Monthly Medicaid Patient Liability Amount	PR	Collect from Patient	→
OA-143	Portion of Payment Deferred	OA	Review & Decide	→
CO-144	Incentive Adjustment for Preferred Product/Service	CO	Review & Decide	→
CO-146	Diagnosis Code Invalid for Date of Service	CO	Resubmit	→
CO-147	Provider Contracted/Negotiated Rate Expired or Not on File	CO	Verify & Resubmit	→
CO-148	Incomplete or Missing Information from Another Provider	CO	Verify & Resubmit	→
CO-149	Lifetime Benefit Maximum Reached	CO	Verify & Resubmit	→
CO-150	Documentation Does Not Support Level of Service	CO	Review & Decide	→
CO-151	Documentation Does Not Support Service Frequency	CO	Review & Decide	→
CO-152	Documentation Does Not Support Length of Service	CO	Review & Decide	→
CO-153	Documentation Does Not Support Prescribed Dosage	CO	Review & Decide	→
CO-154	Documentation Does Not Support Day's Supply of Medication/Supplies	CO	Verify & Resubmit	→
OA-155	Patient Refused the Service/Procedure	OA	Review & Decide	→
CO-157	Service Denied — Provided Due to Act of War	CO	Review & Decide	→
CO-158	Service Provided Outside the United States	CO	Review & Decide	→
CO-159	Service Provided as Result of Terrorism	CO	Verify & Resubmit	→
CO-160	Benefit Exclusion — Activity-Related Injury/Illness	CO	Verify & Resubmit	→
CO-161	Provider Performance Bonus	CO	Appeal	→
CO-163	Attachment/Documentation Not Received	CO	Resubmit	→
CO-164	Attachment/Documentation Not Received Timely	CO	Resubmit	→
CO-166	Payer's Plan Responsibility Ended	CO	Verify & Resubmit	→
CO-167	Diagnosis Not Covered	CO	Verify & Resubmit	→
CO-169	Alternate Benefit Provided	CO	Review & Decide	→
CO-170	Payment Denied — Provider Type Not Eligible	CO	Verify & Resubmit	→
CO-171	Payment Denied — Provider Type in This Facility Type	CO	Verify & Resubmit	→
CO-172	Provider Specialty Adjustment	CO	Appeal	→
CO-173	Service/Equipment Not Prescribed by Physician	CO	Verify & Resubmit	→
CO-174	Service Not Prescribed Prior to Delivery	CO	Verify & Resubmit	→
CO-175	Incomplete Prescription	CO	Verify & Resubmit	→
CO-176	Prescription Not Current	CO	Verify & Resubmit	→
CO-177	Patient Eligibility Requirements Not Met	CO	Appeal	→
CO-178	Spend Down Requirements Not Met	CO	Review & Decide	→
CO-179	Waiting Requirements Not Met	CO	Appeal	→
CO-180	Residency Requirements Not Met	CO	Appeal	→
CO-181	Invalid Procedure Code on Date of Service	CO	Resubmit	→
CO-182	Invalid Procedure Modifier	CO	Verify & Resubmit	→
CO-183	Referring Provider Not Authorized to Refer	CO	Verify & Resubmit	→
CO-184	Ordering/Prescribing Provider Not Eligible	CO	Verify & Resubmit	→
CO-185	Rendering Provider Not Eligible to Perform Service	CO	Verify & Resubmit	→
CO-186	Level of Care Change Adjustment	CO	Appeal	→
PR-187	Consumer Spending Account Payment Not Approved	PR	Collect from Patient	→
CO-188	Product/Procedure Not Covered Unless FDA-Recommended	CO	Appeal	→
CO-189	Unlisted/NOC Code Used When Specific Code Exists	CO	Verify & Resubmit	→
CO-190	Payment Included in SNF Qualified Stay Allowance	CO	Review & Decide	→
OA-192	Non-Standard COB Adjustment Code	OA	Verify & Resubmit	→
CO-193	Original Payment Decision Maintained	CO	Appeal	→
CO-194	Anesthesia by Operating/Assistant/Attending Physician	CO	Verify & Resubmit	→
OA-195	Refund Issued to Wrong Payer	OA	Verify & Resubmit	→
CO-197	Precertification/Authorization/Notification Absent	CO	Verify & Resubmit	→
CO-198	Precertification/Authorization Limits Exceeded	CO	Appeal	→
CO-199	Revenue Code / Procedure Code Mismatch	CO	Resubmit	→
CO-200	Expenses Incurred During Lapse in Coverage	CO	Verify & Resubmit	→
PR-201	Workers' Comp Settlement — Patient Responsibility per Agreement	PR	Collect from Patient	→
CO-202	Non-Covered Personal Comfort or Convenience Services	CO	Review & Decide	→
CO-203	Discontinued or Reduced Service	CO	Resubmit	→
PR-204	Service/Equipment/Drug Not Covered Under Benefit Plan	PR	Appeal	→
CO-205	Pharmacy Discount Card Processing Fee	CO	Verify & Resubmit	→
CO-206	NPI Not On File With Payer	CO	Verify & Resubmit	→
CO-207	Invalid NPI Format	CO	Resubmit	→
CO-208	NPI Billing Provider Not Matched	CO	Verify & Resubmit	→
OA-209	Regulatory Non-Collectible Amount	OA	Verify & Resubmit	→
CO-210	Pre-Certification/Authorization Not Timely	CO	Verify & Resubmit	→
CO-211	NDC Not Eligible for Rebate / Not Covered	CO	Verify & Resubmit	→
CO-212	Administrative Surcharges Not Covered	CO	Review & Decide	→
CO-213	Physician Self-Referral Prohibition Violation	CO	Appeal	→
CO-215	Third Party Subrogation Settlement	CO	Review & Decide	→
CO-216	Review Organization Findings	CO	Appeal	→
CO-219	Extent of Injury Adjustment	CO	Review & Decide	→
CO-222	Exceeds Contracted Maximum Units	CO	Review & Decide	→
CO-223	Mandated Federal/State/Local Law Adjustment	CO	Review & Decide	→
CO-224	Patient Identity Compromised	CO	Verify & Resubmit	→
CO-225	Penalty or Interest Payment by Payer	CO	Review & Decide	→
CO-226	Provider Information Not Provided or Incomplete	CO	Verify & Resubmit	→
PR-227	Patient/Insured Information Not Provided	PR	Collect from Patient	→
CO-228	Information Not Provided to Previous Payer	CO	Verify & Resubmit	→
PR-229	Medicare Partial Charge on 12X Bill Type	PR	Verify & Resubmit	→
CO-231	Mutually Exclusive Procedures on Same Day	CO	Appeal	→
CO-232	Institutional Transfer DRG Difference	CO	Verify & Resubmit	→
CO-233	Hospital-Acquired Condition or Preventable Error	CO	Appeal	→
CO-234	Procedure Not Paid Separately (Bundled)	CO	Resubmit	→
CO-235	Sales Tax Not Reimbursable	CO	Resubmit	→
CO-236	Incompatible Procedure/Modifier Combination	CO	Resubmit	→
CO-237	Legislated or Regulatory Penalty	CO	Appeal	→
PR-238	Ineligible Coverage Period Reduction	PR	Collect from Patient	→
CO-239	Claim Spans Eligible and Ineligible Periods — Rebill	CO	Resubmit	→
CO-240	Diagnosis Inconsistent with Birth Weight	CO	Resubmit	→
PR-241	Low Income Subsidy Co-payment Adjustment	PR	Collect from Patient	→
CO-242	Services Not Provided by Network Provider	CO	Review & Decide	→
CO-243	Services Not Authorized by Network Provider	CO	Appeal	→
CO-245	Provider Performance Program Withhold	CO	Review & Decide	→
CO-246	Non-Payable Code — Required Reporting Only	CO	Review & Decide	→
PR-247	Professional Service Deductible on Institutional Claim	PR	Collect from Patient	→
PR-248	Professional Service Coinsurance on Institutional Claim	PR	Collect from Patient	→
CO-249	Claim Identified as Readmission	CO	Appeal	→
CO-250	Incorrect Attachment Received — Expected Document Still Missing	CO	Resubmit	→
CO-251	Incomplete or Deficient Attachment — Information Still Needed	CO	Resubmit	→
CO-252	Attachment Required to Adjudicate Claim	CO	Resubmit	→
CO-253	Sequestration — Medicare Federal Payment Reduction	CO	Review & Decide	→
CO-254	Dental Plan Received Claim — Benefits Not Available, Submit to Medical Plan	CO	Resubmit	→
CO-256	Service Not Payable Per Managed Care Contract	CO	Review & Decide	→
OA-257	Grace Period Pending — Claim Disposition Undetermined	OA	Review & Decide	→
CO-258	Patient in Custody or Incarcerated — Coverage Not Available	CO	Verify & Resubmit	→
CO-259	Additional Payment for Dental/Vision Service Utilization	CO	Review & Decide	→
CO-260	Medicaid ACA Enhanced Fee Schedule Adjustment	CO	Review & Decide	→
CO-261	Procedure Inconsistent with Patient History	CO	Appeal	→
CO-262	Pharmaceutical Delivery Cost Adjustment	CO	Verify & Resubmit	→
CO-263	Pharmaceutical Shipping Cost Adjustment	CO	Verify & Resubmit	→
CO-264	Pharmaceutical Postage Cost Adjustment	CO	Verify & Resubmit	→
CO-265	Pharmaceutical Administrative Cost Adjustment	CO	Verify & Resubmit	→
CO-266	Pharmaceutical Compound Preparation Cost Adjustment	CO	Verify & Resubmit	→
CO-267	Claim Spans Multiple Months	CO	Resubmit	→
CO-268	Claim Spans Two Calendar Years	CO	Resubmit	→
CO-269	Anesthesia Not Covered for This Service	CO	Appeal	→
CO-270	Submit to Dental Plan Instead	CO	Resubmit	→
OA-271	Prior Contractual Reduction on Periodic Payment	OA	Review & Decide	→
CO-272	Coverage/Program Guidelines Not Met	CO	Appeal	→
CO-273	Coverage/Program Guidelines Exceeded	CO	Appeal	→
CO-274	Fee/Service Not Payable — Care Coordination Arrangement	CO	Verify & Resubmit	→
PR-275	Prior Payer's Patient Responsibility Not Covered	PR	Collect from Patient	→
CO-276	Services Denied by Prior Payer Not Covered	CO	Appeal	→
OA-277	Claim Undetermined During Premium Grace Period (SHOP)	OA	Review & Decide	→
CO-278	Performance Program Proficiency Requirements Not Met	CO	Verify & Resubmit	→
CO-279	Services Not Provided by Preferred Network Providers	CO	Verify & Resubmit	→
CO-280	Claim Received but Benefits Not Covered — Submit to Pharmacy Plan	CO	Resubmit	→
CO-281	Deductible Waived Per Contractual Agreement	CO	Verify & Resubmit	→
CO-282	Procedure/Revenue Code Inconsistent with Type of Bill	CO	Resubmit	→
CO-283	Attending Provider Not Eligible to Direct Care	CO	Verify & Resubmit	→
CO-284	Authorization Valid but Not Applicable to Billed Services	CO	Verify & Resubmit	→
CO-285	Appeal Procedures Not Followed	CO	Appeal	→
CO-286	Appeal Time Limits Not Met	CO	Review & Decide	→
CO-287	Referral Exceeded	CO	Verify & Resubmit	→
CO-288	Referral Absent / Missing Referral	CO	Verify & Resubmit	→
CO-289	Dental/Medical Plan Benefits Not Available	CO	Review & Decide	→
OA-290	Dental Plan Claim Forwarded to Medical Plan	OA	Verify & Resubmit	→
OA-291	Medical Plan Claim Forwarded to Dental Plan	OA	Verify & Resubmit	→
OA-292	Medical Plan Claim Forwarded to Pharmacy Plan	OA	Verify & Resubmit	→
OA-293	Payment Made to Employer	OA	Review & Decide	→
OA-294	Payment Made to Attorney	OA	Review & Decide	→
CO-295	Pharmacy Direct/Indirect Remuneration (DIR) Adjustment	CO	Review & Decide	→
CO-296	Precertification/Authorization Number Does Not Apply to Provider	CO	Verify & Resubmit	→
CO-297	Medical Plan Claim — Submit to Vision Plan	CO	Verify & Resubmit	→
OA-298	Medical Plan Claim Forwarded to Vision Plan	OA	Verify & Resubmit	→
CO-299	Billing Provider Not Eligible for Payment	CO	Verify & Resubmit	→
OA-300	Medical Plan Claim Forwarded to Behavioral Health Plan	OA	Verify & Resubmit	→
CO-301	Medical Plan Claim — Submit to Behavioral Health Plan	CO	Verify & Resubmit	→
CO-302	Authorization Time Limit Expired	CO	Appeal	→
CO-303	QMB Patient Responsibility Not Covered	CO	Review & Decide	→
CO-304	Benefits Not Available — Submit to Hearing Plan	CO	Verify & Resubmit	→
CO-305	Claim Forwarded to Hearing Plan	CO	Verify & Resubmit	→
CO-306	Type of Bill Inconsistent with Patient Status	CO	Verify & Resubmit	→
CO-307	Medicare Drug Price Negotiation Refund	CO	Review & Decide	→
CO-308	Contracted Funding Agreement Adjustment	CO	Review & Decide	→
CO-A0	Patient Refund Amount	CO	Review & Decide	→
CO-A1	Missing Remark Code	CO	Verify & Resubmit	→
CO-A5	Medicare PPS Capital Cost Outlier Amount	CO	Review & Decide	→
CO-A6	Prior Hospitalization or 30-Day Transfer Requirement Not Met	CO	Appeal	→
CO-A8	Ungroupable DRG	CO	Verify & Resubmit	→
CO-B1	Non-Covered Visits	CO	Review & Decide	→
CO-B10	Allowed Amount Reduced — Component Already Paid	CO	Verify & Resubmit	→
CO-B11	Claim Transferred to Proper Payer	CO	Verify & Resubmit	→
CO-B12	Services Not Documented in Medical Records	CO	Appeal	→
CO-B13	Previously Paid Service	CO	Review & Decide	→
CO-B14	Only One Visit Per Physician Per Day Covered	CO	Verify & Resubmit	→
CO-B15	Qualifying Service/Procedure Not Received	CO	Verify & Resubmit	→
CO-B16	New Patient Qualifications Not Met	CO	Verify & Resubmit	→
CO-B20	Service Furnished by Another Provider	CO	Verify & Resubmit	→
CO-B22	Payment Adjusted Based on Diagnosis	CO	Verify & Resubmit	→
CO-B23	Procedure Not Authorized per CLIA Proficiency Test	CO	Verify & Resubmit	→
CO-B4	Late Filing Penalty	CO	Review & Decide	→
CO-B7	Provider Not Certified/Eligible	CO	Verify & Resubmit	→
CO-B8	Alternative Services Not Utilized	CO	Appeal	→
CO-B9	Patient Enrolled in Hospice	CO	Verify & Resubmit	→
CO-P1	State Mandated Requirement — Property and Casualty	CO	Verify & Resubmit	→
OA-P10	Payment Reduced to Zero Pending Litigation	OA	Review & Decide	→
OA-P11	P&C Claim Disposition Pending Litigation	OA	Review & Decide	→
CO-P12	Workers' Compensation Jurisdictional Fee Schedule Adjustment	CO	Review & Decide	→
CO-P13	Workers' Compensation Jurisdictional Regulation Adjustment	CO	Review & Decide	→
CO-P14	Benefit Included in Another Same-Day Service	CO	Verify & Resubmit	→
CO-P15	Workers' Compensation Medical Treatment Guideline Adjustment	CO	Appeal	→
CO-P16	Provider Not Authorized to Treat Injured Workers	CO	Verify & Resubmit	→
CO-P2	Non-Work Related Injury/Illness	CO	Verify & Resubmit	→
PR-P3	Workers' Compensation Case Settled — Patient Responsibility	PR	Collect from Patient	→
CO-P4	Workers' Compensation Claim Non-Compensable	CO	Verify & Resubmit	→
CO-P5	Reasonable and Customary Fee Adjustment (No Legislated Maximum)	CO	Review & Decide	→
CO-P6	Benefits Entitlement Adjustment	CO	Verify & Resubmit	→
CO-P7	Billed Code Not in Fee Schedule/Database	CO	Resubmit	→
OA-P8	Claim Under Investigation	OA	Review & Decide	→
CO-P9	No CPT/HCPCS Code Available for Service	CO	Resubmit	→