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 Inconsistent with Modifier	CO	Verify & Resubmit	→
CO-5	Procedure Code Inconsistent with Place of Service	CO	Verify & Resubmit	→
CO-6	Procedure/Revenue Code Inconsistent with Patient Age	CO	Verify & Resubmit	→
CO-7	Procedure/Revenue Code Inconsistent with Patient Gender	CO	Verify & Resubmit	→
CO-8	Procedure Code Inconsistent with Provider Type/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/Service	CO	Review & Decide	→
CO-19	Workers' Compensation Claim	CO	Resubmit	→
CO-20	Liability Carrier Responsible	CO	Resubmit	→
CO-21	No-Fault Carrier Responsible	CO	Resubmit	→
CO-22	Coordination of Benefits - Another Payer May Cover	CO	Resubmit	→
CO-23	Prior Payer Adjudication Impact	CO	Review & Decide	→
CO-24	Charges Covered Under Capitation/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 Cannot Be Identified as Insured	CO	Verify & Resubmit	→
CO-32	Patient Not Eligible Dependent	CO	Verify & Resubmit	→
CO-33	Insured Has No Dependent Coverage	CO	Verify & Resubmit	→
CO-34	No Coverage for Newborns	CO	Verify & Resubmit	→
CO-35	Lifetime Benefit Maximum Reached	CO	Review & Decide	→
CO-39	Services Denied at Authorization/Pre-certification	CO	Appeal	→
CO-40	Charges Do Not Meet Emergent/Urgent Care Qualifications	CO	Appeal	→
CO-44	Prompt-Pay Discount	CO	Review & Decide	→
CO-45	Charge Exceeds Fee Schedule/Maximum Allowable	CO	Review & Decide	→
CO-49	Non-Covered Routine/Preventive Exam	CO	Appeal	→
CO-50	Non-Covered Service - Not Medically Necessary	CO	Appeal	→
CO-51	Non-Covered Pre-existing Condition	CO	Appeal	→
CO-53	Services by Immediate Relative Not Covered	CO	Review & Decide	→
CO-54	Multiple Physicians/Assistants Not Covered	CO	Appeal	→
CO-55	Procedure/Treatment Deemed Experimental/Investigational	CO	Appeal	→
CO-56	Procedure/Treatment Not Proven Effective	CO	Appeal	→
CO-58	Inappropriate or Invalid Place of Service	CO	Appeal	→
CO-59	Multiple/Concurrent Procedure Rules Applied	CO	Review & Decide	→
CO-60	Outpatient Services Not Covered Near Inpatient Stay	CO	Review & Decide	→
CO-61	Failure to Obtain Second Surgical Opinion	CO	Appeal	→
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	Verify & 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	Verify & Resubmit	→
CO-111	Not Covered Unless Provider Accepts Assignment	CO	Verify & Resubmit	→
CO-112	Service Not Furnished Directly or Not Documented	CO	Verify & Resubmit	→
CO-114	Procedure/Product Not FDA Approved	CO	Verify & Resubmit	→
CO-115	Procedure Postponed, Canceled, or Delayed	CO	Verify & Resubmit	→
CO-116	Advance Indemnification Notice Requirements Not Met	CO	Review & Decide	→
CO-117	Transportation to Nearest Facility	CO	Verify & Resubmit	→
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	Verify & Resubmit	→
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	Review & Decide	→
CO-139	Contracted Funding Agreement — Subscriber Employed by Provider	CO	Review & Decide	→
CO-140	Patient ID Number and Name Do Not Match	CO	Verify & 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 Invalid for Date of Service	CO	Verify & Resubmit	→
CO-147	Provider Accepted Reduced Payment from Regulatory Authority	CO	Review & Decide	→
CO-148	Information from Another Provider Not Provided or Incomplete	CO	Verify & Resubmit	→
CO-149	Lifetime Benefit Maximum Reached	CO	Review & Decide	→
CO-150	Information Does Not Support Level of Service	CO	Appeal	→
CO-151	Information Does Not Support Frequency of Services	CO	Appeal	→
CO-152	Information Does Not Support Length of Service	CO	Appeal	→
CO-153	Information Does Not Support Dosage	CO	Appeal	→
CO-154	Information Does Not Support Day's Supply	CO	Verify & Resubmit	→
CO-155	Patient Refused the Service/Procedure	CO	Review & Decide	→
CO-157	Service Provided as Result of Act of War	CO	Appeal	→
CO-158	Service Provided Outside the United States	CO	Review & Decide	→
CO-159	Service Provided as Result of Terrorism	CO	Appeal	→
CO-160	Benefit Exclusion: Injury from Excluded Activity	CO	Appeal	→
CO-161	Provider Performance Bonus	CO	Review & Decide	→
CO-163	Attachment/Documentation Referenced on Claim Not Received	CO	Resubmit	→
CO-164	Attachment/Documentation Not Received in Timely Fashion	CO	Appeal	→
CO-166	Payer's Responsibility Ended Before Service Date	CO	Verify & Resubmit	→
CO-167	Diagnosis Not Covered	CO	Verify & Resubmit	→
CO-169	Alternate Benefit Provided	CO	Review & Decide	→
CO-170	Payment Denied for This Provider Type	CO	Verify & Resubmit	→
CO-171	Payment Denied for Provider Type in This Facility Type	CO	Verify & Resubmit	→
CO-172	Payment Adjusted for Provider Specialty	CO	Verify & Resubmit	→
CO-173	Service Not Prescribed by a Physician	CO	Resubmit	→
CO-174	Service Not Prescribed Prior to Delivery	CO	Verify & Resubmit	→
CO-175	Prescription Is Incomplete	CO	Resubmit	→
CO-176	Prescription Is Not Current	CO	Resubmit	→
CO-177	Patient Has Not Met Required Eligibility Requirements	CO	Review & Decide	→
CO-178	Patient Has Not Met Spend Down Requirements	CO	Verify & Resubmit	→
CO-179	Patient Has Not Met Required Waiting Period	CO	Review & Decide	→
CO-180	Patient Has Not Met Residency Requirements	CO	Review & Decide	→
CO-181	Procedure Code Invalid on Date of Service	CO	Verify & Resubmit	→
CO-182	Procedure Modifier Invalid on Date of Service	CO	Verify & Resubmit	→
CO-183	Referring Provider Not Eligible to Refer	CO	Verify & Resubmit	→
CO-184	Prescribing/Ordering Provider Not Eligible to Prescribe/Order	CO	Verify & Resubmit	→
CO-185	Rendering Provider Not Eligible to Perform Service	CO	Verify & Resubmit	→
CO-186	Level of Care Change Adjustment	CO	Appeal	→
CO-187	Consumer Spending Account Payment Not Approved	CO	Review & Decide	→
CO-188	Product/Procedure Not Covered Unless FDA-Recommended	CO	Appeal	→
CO-189	No Specific Procedure Code for Service Billed	CO	Verify & Resubmit	→
CO-190	Billing for SNF Qualified Stay Already Covered	CO	Review & Decide	→
CO-192	Non-Standard Adjustment Code from Paper Remittance	CO	Verify & Resubmit	→
CO-193	Original Payment Decision Maintained on Review	CO	Appeal	→
CO-194	Anesthesia by Operating/Assistant/Attending Physician	CO	Verify & Resubmit	→
OA-195	Refund to Erroneous Priority 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 and Procedure Code Mismatch	CO	Verify & Resubmit	→
CO-200	Expenses Incurred During Lapse in Coverage	CO	Verify & Resubmit	→
PR-201	Patient Responsibility via Set-Aside Arrangement	PR	Collect from Patient	→
CO-202	Non-Covered Personal Comfort or Convenience Services	CO	Appeal	→
CO-203	Discontinued or Reduced Service	CO	Verify & Resubmit	→
CO-204	Service/Equipment/Drug Not Covered Under Benefit Plan	CO	Appeal	→
CO-205	Pharmacy Discount Card Processing Fee	CO	Review & Decide	→
CO-206	National Provider Identifier - Missing	CO	Verify & Resubmit	→
CO-207	National Provider Identifier - Invalid Format	CO	Verify & Resubmit	→
CO-208	National Provider Identifier - Not Matched	CO	Verify & Resubmit	→
OA-209	Provider Cannot Collect from Patient per Regulatory Agreement	OA	Review & Decide	→
CO-210	Pre-Certification/Authorization Not Received Timely	CO	Appeal	→
CO-211	National Drug Codes (NDC) Not Eligible for Rebate, Not Covered	CO	Verify & Resubmit	→
CO-212	Administrative Surcharges Not Covered	CO	Review & Decide	→
CO-213	Non-Compliance with Physician Self-Referral Prohibition	CO	Appeal	→
CO-215	Based on Subrogation of a Third Party Settlement	CO	Review & Decide	→
CO-216	Based on Findings of a Review Organization	CO	Appeal	→
CO-219	Based on Extent of Injury	CO	Appeal	→
CO-222	Exceeds Contracted Maximum Hours/Days/Units	CO	Appeal	→
CO-223	Mandated Federal/State/Local Law Adjustment	CO	Review & Decide	→
CO-224	Patient Identification Compromised by Identity Theft	CO	Verify & Resubmit	→
OA-225	Penalty or Interest Payment by Payer	OA	Review & Decide	→
CO-226	Provider Information Not Provided or Insufficient	CO	Verify & Resubmit	→
CO-227	Patient/Insured Information Not Provided or Insufficient	CO	Verify & Resubmit	→
CO-228	Denied for Failure to Supply Information to Previous Payer	CO	Verify & Resubmit	→
PR-229	Partial Charge Not Considered Due to Type of Bill 12X	PR	Collect from Patient	→
CO-231	Mutually Exclusive Procedures	CO	Verify & Resubmit	→
CO-232	Institutional Transfer Amount	CO	Review & Decide	→
CO-233	Hospital-Acquired Condition or Preventable Medical Error	CO	Appeal	→
CO-234	Procedure Not Paid Separately	CO	Verify & Resubmit	→
CO-235	Sales Tax	CO	Review & Decide	→
CO-236	Procedure/Modifier Not Compatible per NCCI	CO	Verify & Resubmit	→
CO-237	Legislated/Regulatory Penalty	CO	Review & Decide	→
PR-238	Claim Spans Eligible/Ineligible Periods - Ineligible Reduction	PR	Collect from Patient	→
CO-239	Claim Spans Eligible/Ineligible Periods - Rebill Separately	CO	Verify & Resubmit	→
CO-240	Diagnosis Inconsistent with Patient's Birth Weight	CO	Verify & Resubmit	→
PR-241	Low Income Subsidy (LIS) Co-payment Amount	PR	Collect from Patient	→
CO-242	Services Not Provided by Network/Primary Care Providers	CO	Appeal	→
CO-243	Services Not Authorized by Network/Primary Care Providers	CO	Appeal	→
CO-245	Provider Performance Program Withhold	CO	Review & Decide	→
CO-246	Non-Payable Code for Required Reporting Only	CO	Review & Decide	→
PR-247	Deductible for Professional Service in Institutional Setting	PR	Collect from Patient	→
PR-248	Coinsurance for Professional Service in Institutional Setting	PR	Collect from Patient	→
CO-249	Claim Identified as Readmission	CO	Appeal	→
CO-250	Incorrect Attachment/Documentation Received	CO	Verify & Resubmit	→
CO-251	Incomplete or Deficient Attachment/Documentation Received	CO	Verify & Resubmit	→
CO-252	Attachment Required to Adjudicate Claim	CO	Resubmit	→
CO-253	Sequestration Reduction in Federal Payment	CO	Review & Decide	→
CO-254	Dental Plan Benefits Not Available - Submit to Medical	CO	Resubmit	→
CO-256	Service Not Payable Per Managed Care Contract	CO	Review & Decide	→
OA-257	Claim Undetermined During Premium Grace Period (HIX)	OA	Review & Decide	→
CO-258	Claim Not Covered - Patient in Custody or Incarcerated	CO	Resubmit	→
CO-259	Additional Payment for Dental/Vision Service Utilization	CO	Verify & Resubmit	→
CO-260	Processed Under Medicaid ACA Enhanced Fee Schedule	CO	Review & Decide	→
CO-261	Procedure Inconsistent with Patient History	CO	Appeal	→
CO-262	Adjustment for Delivery Cost (Pharmaceuticals Only)	CO	Verify & Resubmit	→
CO-263	Adjustment for Shipping Cost (Pharmaceuticals Only)	CO	Verify & Resubmit	→
CO-264	Adjustment for Postage Cost (Pharmaceuticals Only)	CO	Verify & Resubmit	→
CO-265	Adjustment for Administrative Cost (Pharmaceuticals Only)	CO	Verify & Resubmit	→
CO-266	Adjustment for Compound Preparation Cost (Pharmaceuticals Only)	CO	Verify & Resubmit	→
CO-267	Claim/Service Spans Multiple Months	CO	Resubmit	→
CO-268	Claim Spans Two Calendar Years	CO	Resubmit	→
CO-269	Anesthesia Not Covered for This Procedure	CO	Appeal	→
CO-270	Medical Plan Benefits Not Available - Submit to Dental	CO	Resubmit	→
OA-271	Prior Contractual Reductions on Current Payment Schedule	OA	Review & Decide	→
CO-272	Coverage/Program Guidelines Were Not Met	CO	Appeal	→
CO-273	Coverage/Program Guidelines Were Exceeded	CO	Appeal	→
CO-274	Fee/Service Not Payable — Care Coordination Arrangement	CO	Verify & Resubmit	→
PR-275	Prior Payer Patient Responsibility Not Covered	PR	Collect from Patient	→
CO-276	Prior Payer Denied Services Not Covered by This Payer	CO	Appeal	→
OA-277	Claim Undetermined During SHOP Exchange Grace Period	OA	Review & Decide	→
CO-278	Performance Program Proficiency Requirements Not Met	CO	Review & Decide	→
CO-279	Services Not Provided by Preferred Network Providers	CO	Appeal	→
CO-280	Medical Plan Benefits Not Available - Submit to Pharmacy	CO	Resubmit	→
CO-281	Deductible Waived Per Contractual Agreement	CO	Review & Decide	→
CO-282	Procedure/Revenue Code Does Not Match Type of Bill	CO	Resubmit	→
CO-283	Attending Provider Not Eligible to Direct Care	CO	Verify & Resubmit	→
CO-284	Authorization Valid But Does Not Apply to Billed Services	CO	Verify & Resubmit	→
CO-285	Appeal Procedures Not Followed	CO	Appeal	→
CO-286	Appeal Time Limits Not Met	CO	Appeal	→
CO-287	Referral Exceeded	CO	Verify & Resubmit	→
CO-288	Referral Absent	CO	Verify & Resubmit	→
CO-289	Dental and Medical Plans Considered - Benefits Not Available	CO	Review & Decide	→
CO-290	Dental Plan Benefits Not Available - Forwarded to Medical	CO	Resubmit	→
CO-291	Medical Plan Benefits Not Available - Forwarded to Dental	CO	Resubmit	→
CO-292	Medical Plan Benefits Not Available - Forwarded to Pharmacy	CO	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	Authorization Valid But Does Not Apply to Provider	CO	Verify & Resubmit	→
CO-297	Medical Plan Benefits Not Available - Submit to Vision	CO	Resubmit	→
CO-298	Medical Plan Benefits Not Available - Forwarded to Vision	CO	Resubmit	→
CO-299	Billing Provider Not Eligible for Payment	CO	Verify & Resubmit	→
CO-300	Medical Plan Benefits Not Available - Submit to Behavioral Health	CO	Resubmit	→
CO-301	Medical Plan Claim — Submit to Behavioral Health Plan	CO	Verify & Resubmit	→
CO-302	Precertification/Authorization Time Limit Expired	CO	Verify & Resubmit	→
CO-303	Prior Payer Patient Responsibility Not Covered for QMB	CO	Review & Decide	→
CO-304	Medical Plan Claim — Submit to Hearing Plan	CO	Verify & Resubmit	→
CO-305	Medical Plan Claim — Forwarded to Hearing Plan	CO	Review & Decide	→
CO-306	Type of Bill Inconsistent with Patient Status	CO	Resubmit	→
CO-307	Medicare Maximum Fair Price Standard Default Refund Amount	CO	Review & Decide	→
CO-308	Contracted Funding Agreement Adjustment	CO	Review & Decide	→
CO-A0	Patient Refund Amount	CO	Review & Decide	→
CO-A1	Claim/Service Denied — Remark Code Required	CO	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	Resubmit	→
CO-B1	Non-Covered Visits	CO	Review & Decide	→
CO-B10	Allowed Amount Reduced — Component of Basic Procedure Already Paid	CO	Review & Decide	→
CO-B11	Claim Transferred to Proper Payer — Not Covered Here	CO	Verify & Resubmit	→
CO-B12	Services Not Documented in Patient Medical Records	CO	Appeal	→
CO-B13	Previously Paid — Duplicate Payment	CO	Review & Decide	→
CO-B14	Only One Visit/Consultation Per Physician Per Day Covered	CO	Resubmit	→
CO-B15	Qualifying Service/Procedure Not Received or Covered	CO	Verify & Resubmit	→
CO-B16	New Patient Qualifications Not Met	CO	Resubmit	→
CO-B20	Service Partially or Fully Furnished by Another Provider	CO	Resubmit	→
CO-B22	Payment Adjusted Based on Diagnosis	CO	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 for This Service on This Date	CO	Verify & Resubmit	→
CO-B8	Alternative Services Available — Should Have Been Utilized	CO	Appeal	→
CO-B9	Patient Enrolled in Hospice	CO	Verify & Resubmit	→
CO-P1	State-Mandated Requirement — Property and Casualty Only	CO	Review & Decide	→
CO-P10	Payment Reduced to Zero Due to Litigation — P&C Only	CO	Review & Decide	→
CO-P11	P&C Claim Disposition Pending Due to Litigation	CO	Review & Decide	→
CO-P12	Workers' Compensation Jurisdictional Fee Schedule Adjustment	CO	Review & Decide	→
CO-P13	Payment Reduced/Denied Per WC Jurisdictional Regulations	CO	Appeal	→
CO-P14	Service Included in Another Service Payment — P&C Only	CO	Review & Decide	→
CO-P15	WC Medical Treatment Guideline Adjustment	CO	Appeal	→
CO-P16	Provider Not Authorized for WC Treatment in This Jurisdiction	CO	Verify & Resubmit	→
CO-P2	Not Work-Related — Workers' Compensation Not Liable	CO	Verify & Resubmit	→
PR-P3	Workers' Compensation Case Settled — Patient Responsible via MSA	PR	Collect from Patient	→
CO-P4	Workers' Compensation Claim Non-Compensable	CO	Verify & Resubmit	→
CO-P5	Reasonable and Customary Fee Adjustment — P&C Only	CO	Review & Decide	→
CO-P6	Adjustment Based on Entitlement to Benefits — P&C Only	CO	Verify & Resubmit	→
CO-P7	Billed Code Not in Fee Schedule/Database — P&C Only	CO	Resubmit	→
CO-P8	Claim Under Investigation — P&C Only	CO	Review & Decide	→
CO-P9	No CPT/HCPCS Code Available — P&C Only	CO	Resubmit	→