CARC 224 Active

PR-224: Patient Identification Compromised by Identity Theft

TL;DR

Patient responsibility is assigned pending identity verification. Resolve the identity issue first.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
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 PR-224 Mean?

With PR (Patient Responsibility), the patient may be responsible if the identity issue cannot be resolved. This is unusual and requires careful handling.

CARC 224 indicates that the payer has identified a potential identity theft issue with the patient's insurance information. The patient's identification may have been reported as compromised, flagged for suspicious activity, or involved in known fraud schemes. The payer cannot process the claim until the identity is verified.

This code protects patients from fraudulent use of their insurance information and protects payers from paying fraudulent claims. Resolution requires working with the patient and payer to verify the patient's identity and ensure the claim is legitimate.

How to Resolve

  1. Resolve the identity issue Work with the patient and payer to verify identity before collecting.
  2. Collect if identity is confirmed If identity is verified and PR applies, collect from the patient.
Do Not Appeal This Code

This claim was denied because the patient's identity has been compromised by identity theft. Complete the payer's identity verification process and resubmit the claim once verification is confirmed. An appeal is not the appropriate resolution.

How to Prevent PR-224

Also Filed As

The same CARC 224 may appear with different Group Codes:

CO-224 OA-224

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

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.