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CARC 276 · CO-276

CARC 276 Denial: Services denied by the prior payer(s) are not covered by this payer — How to Fix and Appeal

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

TL;DR

CARC 276 (X12 Services denied by the prior payer(s) are not covered by this payer). CARC 276 is a secondary-payer denial: because the primary payer denied the service, this payer won't cover it either (common in pure COB scenarios where secondary adjudication mirrors primary).

Official X12 description

“Services denied by the prior payer(s) are not covered by this payer.”

Source: X12 Claim Adjustment Reason Codes. The X12 External Code Lists are the single authoritative source for every CARC descriptor — always verify against the current release before building a claim-scrub rule.

What CARC 276 actually means

CARC 276 is a secondary-payer denial: because the primary payer denied the service, this payer won't cover it either (common in pure COB scenarios where secondary adjudication mirrors primary). Work the primary denial first; if the primary overturns, the secondary typically follows.

Common root causes

  • Primary payer denied (authorization, medical necessity, benefit design), and the secondary cascade denies.

Prevention checklist

  • Primary-first work queue that holds secondary claims until primary resolves.

Appeal strategy — step by step

Most CARC 276 denials clear faster with the right remediation than with a formal appeal. Work the steps in order and escalate only when a lower-effort path has been ruled out.

  1. 1Reverse the primary denial first; the secondary typically reprocesses automatically or on a single outreach.
  2. 2If the primary denial is contractual, consider shifting to patient responsibility.
Sample appeal-letter language for CARC 276
[Provider letterhead] Re: Appeal of CARC 276 — Claim #{claim_number} Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} On {remittance_date} this claim was adjusted with CARC 276: "Services denied by the prior payer(s) are not covered by this payer." We respectfully request reconsideration. The X12 External Code List definition of CARC 276 does not apply to this claim for the following reasons: 1. [Cite the clinical / coding / policy fact that rebuts the adjustment] 2. [Cite the supporting documentation attached — op note, EOB, LCD/NCD citation, NCCI edit indicator, modifier rationale] 3. [Cite the payer's own policy where applicable] Attached: {list supporting documents} Please process payment under the member's benefits. If additional information is required, contact the billing office at {provider_phone} or {provider_email}. Sincerely, {billing_manager_name}, {credentials}

Edit the bracketed fields before sending. This template is a starting point; a payer-specific appeal form may still be required — check the provider portal first.

Payer-specific notes

Payer-specific behavior for CARC 276 publishes here as the QuickIntell anonymized denial ETL ingests sufficient volume. In the meantime, consult the payer directory for the relevant provider manual and appeal form.

How common is CARC 276?

Search demand rank
#91

Out of 306 seeded CARCs, ranked by combined US monthly search volume for "CARC 276", "CO-276 denial", and "denial code 276".

Platform frequency
Pending ETL

Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).

How QuickRCM prevents CARC 276

QuickRCM catches the root causes above before the 837 leaves the clearinghouse:

  • Claim-scrub rules fire on every root cause listed above — the scrub references the same X12 CAS segment logic that drives the denial, so what the payer checks, QuickRCM checks first.
  • When a denial lands, QuickRCM routes it to the correct worker with the documentation bundle already attached (op note, LCD citation, modifier rationale, EOB, primary 835).
  • Appeal templates tuned to each CARC (including this one) pull the supporting facts from the claim and fill the bracketed fields automatically.
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Frequently asked questions — CARC 276

What does CARC 276 mean?

CARC 276 is an X12 Claim Adjustment Reason Code. The official definition is: "Services denied by the prior payer(s) are not covered by this payer." In plain English, the payer is telling you cARC 276 is a secondary-payer denial: because the primary payer denied the service, this payer won't cover it either (common in pure COB scenarios where secondary adjudication mirrors primary). Work the primary denial first; if the primary overturns, the secondary typically follows.

How do I resolve a CARC 276 (CO-276) denial?

Start with the most common root cause: Primary payer denied (authorization, medical necessity, benefit design), and the secondary cascade denies. First step: Reverse the primary denial first; the secondary typically reprocesses automatically or on a single outreach. See the full remediation and appeal checklist on this page before filing a formal appeal.

Is CARC 276 patient responsibility?

No — CARC 276 is typically carried under CO (Contractual Obligation) or OA (Other Adjustment), which means it is the provider's responsibility, not the patient's. Do not bill the patient unless the 835 CAS group code is PR.

What does CARC 276 look like on an EOB or 835 remittance?

On the 835 ERA, CARC 276 appears in Loop 2110 CAS segment as "CAS*CO*276*{amount}". On a paper EOB the same code prints in the Adjustment/Denial Reason column with the X12 description: "Services denied by the prior payer(s) are not covered by this payer." — usually paired with one or more RARC remark codes in the same remittance line for additional context.

Which RARC is paired with CARC 276?

CARC 276 is commonly observed with RARC N4. The RARC narrows the reason — for example, pointing at a missing modifier, an LCD citation, or a specific policy. Fix the underlying CARC first; the RARC usually clears with the corrected claim.

Disclaimer

This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. X12 code descriptors are maintained by the X12 External Code Lists; always verify against the current X12 release and the payer's own published policy before submitting or appealing a claim.