CARC 238 Active

CO-238: Claim Spans Eligible/Ineligible Periods - Ineligible Reduction

TL;DR

The ineligible portion is a contractual adjustment. Check if you can bill the patient for the uncovered dates.

Action
Review & Decide
Who Pays
Provider
Appeal
No
Patient Impact
None
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does CO-238 Mean?

With CO, the ineligible portion is a contractual adjustment. The provider may not be able to bill the patient for this period depending on contract terms.

CARC 238 indicates that the claim covers a date range that includes both dates when the patient was eligible for coverage and dates when they were not. The payer reduced the payment to cover only the eligible portion and excluded the ineligible dates. This commonly occurs with inpatient stays or ongoing service episodes where the patient's coverage started or ended during the service period.

For example, if a patient was admitted on January 15 but their coverage did not begin until January 20, the payer would reduce payment to cover only January 20 onward. The provider may need to bill the patient separately for the ineligible dates.

How to Resolve

  1. Review contract terms Determine if the provider can bill the patient for the ineligible period.
  2. Bill the patient if allowed If contract terms permit, bill the patient for the uncovered dates.
  3. Appeal if eligibility dates are wrong If the dates are incorrect, submit proof of coverage.
Do Not Appeal This Code

Claim Spans Eligible/Ineligible Periods - Ineligible Reduction recorded under CO is a contractual obligation — the provider absorbs this amount per the payer agreement. Without an error in how the contract was applied, appeals don't apply. Review the accompanying RARC codes for context and accept the adjustment when the contract terms were applied correctly.

How to Prevent CO-238

Also Filed As

The same CARC 238 may appear with different Group Codes:

PR-238 OA-238

Related Denial Codes

CO-3 — Co-payment Amount CO-85 — Patient Interest Adjustment CO-100 — Payment Made to Patient/Insured CO-101 — Predetermination: Anticipated Payment CO-105 — Tax Withholding Amount

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
  3. https://www.aapc.com/resources/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.