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CARC — Claim Adjustment Reason Codes

CARCs appear in the 835 remittance advice CAS segment and tell you why the payer paid less than the billed amount — bundling, medical necessity, prior-auth gaps, timely-filing, patient responsibility, and contractual adjustments. 306 codes seeded, ordered by US search demand. Every leaf page cites the official X12 description and pairs the RARC partners typically observed on the 835. Source: X12 External Code Lists.

Reviewed by QuickIntell Editorial Team · Last reviewed

Updated

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All CARCs306Bundling / NCCI8Coding / modifier18Medical necessity8Prior authorization15Coverage / eligibility29Timely filing2Patient responsibility20Duplicate2Contractual21Other183

Showing 183 of 306 CARCs in Other.

RankCodeDescription (X12)
#12CARC B7This provider was not certified/eligible to be paid for this procedure/service on this date of service.
#15CARC A1Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
#21CARC 24Charges are covered under a capitation agreement/managed care plan.
#22CARC 226Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete.
#23CARC 227Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete.
#24CARC 151Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
#33CARC 26Expenses incurred prior to coverage.
#34CARC 150Payer deems the information submitted does not support this level of service.
#35CARC 107The related or qualifying claim/service was not identified on this claim.
#36CARC 129Prior processing information appears incorrect.
#37CARC 39Services denied at the time authorization/pre-certification was requested.
#40CARC 272Coverage/program guidelines were not met.
#43CARC 5The procedure code/type of bill is inconsistent with the place of service.
#47CARC 170Payment is denied when performed/billed by this type of provider.
#49CARC 216Based on the findings of a review organization.
#52CARC 181Procedure code was invalid on the date of service.
#56CARC 95Plan procedures not followed.
#58CARC 133The disposition of this service line is pending further review.
#59CARC 185The rendering provider is not eligible to perform the service billed.
#60CARC 193Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.
#61CARC 198Precertification/notification/authorization/pre-treatment exceeded.
#65CARC 286Appeal procedures not followed.
#66CARC B16'New Patient' qualifications were not met.
#67CARC 32Our records indicate that this dependent is not an eligible dependent as defined.
#68CARC 21This injury/illness is the liability of the no-fault carrier.
#70CARC 146Diagnosis was invalid for the date(s) of service reported.
#71CARC 147Provider contracted/negotiated rate expired or not on file.
#72CARC 163Attachment/other documentation referenced on the claim was not received.
#73CARC 208National Provider Identifier - Not matched.
#74CARC 251The attachment/other documentation that was received was incomplete or deficient.
#75CARC 58Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
#78CARC 19This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
#82CARC 40Charges do not meet qualifications for emergent/urgent care.
#85CARC 20This injury/illness is covered by the liability carrier.
#86CARC 6The procedure/revenue code is inconsistent with the patient's age.
#89CARC 206National Provider Identifier - missing.
#90CARC 246This non-payable code is for required reporting only.
#92CARC 56Procedure/treatment has not been deemed 'proven to be effective' by the payer.
#93CARC 125Submission/billing error(s). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
#94CARC 7The procedure/revenue code is inconsistent with the patient's gender.
#95CARC 30Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.
#97CARC 187Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.).
#98CARC 201Workers' Compensation case settled. Patient is responsible for amount of this claim/service through Workers' Compensation 'Medicare set-aside arrangement' or other agreement.
#99CARC 261The procedure or service is inconsistent with the patient's history.
#101CARC 285Appeal procedures not followed.
#107CARC 13The date of death precedes the date of service.
#108CARC 14The date of birth follows the date of service.
#112CARC 44Prompt-pay discount.
#114CARC 52The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
#115CARC 62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.
#116CARC 65Procedure code was incorrect. This payment reflects the correct code.
#118CARC 70Cost outlier - Adjustment to compensate for additional costs.
#119CARC 74Indirect Medical Education Adjustment.
#120CARC 75Direct Medical Education Adjustment.
#121CARC 77Covered days.
#123CARC 87Transfer amount.
#124CARC 88Adjustment amount represents collection against receivable created in prior overpayment.
#125CARC 89Professional fees removed from charges.
#126CARC 90Ingredient cost adjustment.
#127CARC 91Dispensing fee adjustment.
#129CARC 101Predetermination: anticipated payment upon completion of services or claim adjudication.
#130CARC 102Major Medical Adjustment.
#131CARC 103Provider promotional discount (e.g., Senior citizen discount).
#132CARC 104Managed care withholding.
#133CARC 105Tax withholding.
#136CARC 114Procedure/product not approved by the Food and Drug Administration.
#137CARC 115Procedure postponed, canceled, or delayed.
#138CARC 116The advance indemnification notice signed by the patient did not comply with requirements.
#139CARC 122Psychiatric reduction.
#143CARC 152Payer deems the information submitted does not support this length of service.
#144CARC 166These services were submitted after this payer's responsibility for processing claims under this plan ended.
#145CARC 168Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan.
#146CARC 178Payment adjusted because the patient has not met the required spend down requirements.
#147CARC 180Patient has not met the required residency requirements.
#148CARC 186Level of care change adjustment.
#149CARC 188This product/procedure is only covered when used according to FDA recommendations.
#150CARC 190Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.
#151CARC 192Non standard adjustment code from paper remittance.
#152CARC 205Pharmacy discount card processing fee.
#154CARC 219Based on extent of injury.
#156CARC 229Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X.
#157CARC 249This claim has been identified as a readmission.
#159CARC A5Medicare Claim PPS Capital Cost Outlier Amount.
#160CARC 33Insured has no dependent coverage.
#165CARC 61Adjustment for failure to obtain second surgical opinion.
#166CARC 69Day outlier amount.
#167CARC 76Disproportionate Share Adjustment.
#168CARC 85Patient Interest Adjustment (Use Only Group code PR).
#170CARC 110Billing date predates service date.
#171CARC 112Service not furnished directly to the patient and/or not documented.
#172CARC 117Transportation is only covered to the closest facility that can provide the necessary care.
#173CARC 118ESRD network support adjustment.
#174CARC 121Indemnification adjustment - compensation for outstanding member responsibility.
#175CARC 130Claim submission fee.
#176CARC 132Prearranged demonstration project adjustment.
#178CARC 135Interim bills cannot be processed.
#179CARC 137Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
#180CARC 139Contracted funding agreement - Subscriber is employed by the provider of services.
#183CARC 144Incentive adjustment, e.g. preferred product/service.
#186CARC 154Payer deems the information submitted does not support this dosage.
#187CARC 155Patient refused the service/procedure.
#188CARC 157Service/procedure was provided as a result of an act of war.
#189CARC 158Service/procedure was provided outside of the United States.
#191CARC 160Injury/illness was the result of an activity that is a benefit exclusion.
#192CARC 161Provider performance bonus.
#194CARC 169Alternate benefit has been provided.
#196CARC 172Payment is adjusted when performed/billed by a provider of this specialty.
#197CARC 173Service/equipment was not prescribed by a physician.
#198CARC 174Service was not prescribed prior to delivery.
#199CARC 175Prescription is incomplete.
#200CARC 176Prescription is not current.
#201CARC 179Patient has not met the required waiting requirements.
#202CARC 184The prescribing/ordering provider is not eligible to prescribe/order the service billed.
#203CARC 189'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific code available.
#204CARC 199Revenue code and Procedure code do not match.
#207CARC 207National Provider Identifier - Invalid format.
#208CARC 211National Drug Code (NDC) is not eligible for rebate.
#212CARC 223Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.
#213CARC 224Patient identification compromised by identity theft. Identity verification required for processing this and future claims.
#214CARC 225Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837).
#215CARC 228Denied for failure of this provider, payer or subscriber to supply requested information to a previous payer for their adjudication.
#216CARC 232Institutional Transfer Amount.
#217CARC 233Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
#218CARC 235Sales Tax.
#219CARC 237Legislated/Regulatory Penalty.
#220CARC 238Claim spans eligible and ineligible periods of coverage.
#221CARC 239Claim spans eligible and ineligible periods of coverage. Rebill separate claims.
#224CARC 245Provider performance program withhold.
#227CARC 250The attachment/other documentation that was received was the incorrect attachment/document.
#228CARC 254Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's medical plan for further consideration.
#229CARC 257The disposition of the related Property & Casualty claim (injury or illness) is pending due to the Payer's active grace period (as defined by State/Federal laws).
#231CARC 259Additional payment for Dental/Vision service utilization.
#233CARC 262Adjustment for delivery cost.
#234CARC 263Adjustment for shipping cost.
#235CARC 264Adjustment for postage cost.
#236CARC 265Adjustment for administrative cost.
#237CARC 266Adjustment for compound preparation cost.
#238CARC 267Claim/service spans multiple months.
#239CARC 268The Claim spans two calendar years. Please resubmit one claim per calendar year.
#241CARC 270Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's dental plan for further consideration.
#244CARC 278Performance program proficiency requirements not met.
#245CARC 280Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's pharmacy plan for further consideration.
#247CARC 282The procedure/revenue code is inconsistent with the type of bill.
#248CARC 283Attending provider is not eligible to provide direction of care.
#250CARC 290Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's dental plan for further consideration.
#251CARC 291Claim received by the dental plan, but benefits not available under this plan. Claim has been forwarded to the patient's medical plan for further consideration.
#252CARC 292Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's pharmacy plan for further consideration.
#253CARC 293Payment made to employer.
#254CARC 294Payment made to attorney.
#255CARC 295Pharmacy Direct/Indirect Remuneration (DIR).
#257CARC 297Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's vision plan for further consideration.
#258CARC 298Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's vision plan for further consideration.
#259CARC 299The billing provider is not eligible to receive payment for the service billed.
#260CARC 300Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration.
#261CARC 301Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's Behavioral Health Plan for further consideration.
#263CARC 304Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's hearing plan for further consideration.
#264CARC 305Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's hearing plan for further consideration.
#265CARC 306Type of bill is inconsistent with patient status.
#266CARC 307Payment adjusted based on the Medicare Maximum Fair Price Standard.
#268CARC A0Patient refund amount.
#269CARC A6Prior hospitalization or 30 day transfer requirement not met.
#270CARC A8Ungroupable DRG.
#272CARC B4Late filing penalty.
#273CARC B12Services not documented in patient's medical records.
#275CARC B23Procedure billed is not authorized per the Clinical Laboratory Improvement Amendment (CLIA) proficiency test.
#277CARC P2Not a work related injury/illness and thus not the liability of the workers' compensation carrier.
#278CARC P3Workers' Compensation case settled, patient is responsible for further charges.
#281CARC P6Based on entitlement to benefits.
#284CARC P9No available or correlating CPT/HCPCS code to describe this service.
#285CARC P10Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation.
#286CARC P11The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements.
#288CARC P13Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies.
#289CARC P15Workers' Compensation Medical Treatment Guideline Adjustment.
#290CARC P16Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
#294CARC P20Service not paid under jurisdictional regulations or payment policies for outpatient facility.
#295CARC P21Payment denied based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations.
#296CARC P22Payment adjusted based on MPC or PIP Benefits jurisdictional regulations.
#299CARC P25Payment adjusted based on Medical Provider Network (MPN).
#301CARC P27Payment denied based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies.
#302CARC P28Payment adjusted based on Liability Coverage Benefits jurisdictional regulations and/or payment policies.
#304CARC P30Exacerbation of previous condition denied due to incomplete medical documentation.
#305CARC P31Exacerbation of previous condition denied due to treatment exceeding time limits.
#306CARC P32Payment adjusted due to Apportionment as determined by the Workers' Compensation jurisdictional regulations.

Paired with a RARC?

Most CARCs arrive on the 835 alongside one or more Remittance Advice Remark Codes that narrow the reason. See the RARC remark-code reference for the paired explanations.