CARC 276 Active

PR-276: Prior Payer Denied Services Not Covered by This Payer

TL;DR

The secondary payer is not covering services that were denied by the primary payer. Appeal with comprehensive documentation demonstrating the secondary payer should independently cover the service, or redirect the claim to a different payer.

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-276 Mean?

CARC 276 appears when the secondary (current) payer denies coverage for a service that was already denied by the primary (prior) payer. The secondary payer is declining to provide coverage because the primary payer's denial effectively establishes that the service is not covered, and the secondary payer's policy does not override that determination.

This cascading denial is common in coordination of benefits situations where both payers have similar coverage exclusions, the secondary payer's policy defers to the primary payer's coverage decisions, or the secondary payer lacks sufficient documentation to make an independent coverage determination.

The appeal strategy for CARC 276 focuses on demonstrating that the secondary payer should evaluate coverage independently, regardless of the primary payer's decision. If the secondary payer's benefit plan covers the service, the fact that the primary payer denied it should not automatically result in a secondary denial.

How to Resolve

Review both payers' denial reasons, gather documentation, and appeal to the secondary payer for independent coverage review.

  1. Review the prior payer's denial Understand why the primary payer denied the service. Obtain the denial letter and review the specific reason.
  2. Gather complete documentation Compile the primary payer's denial letter, medical records, and clinical documentation supporting the service.
  3. Analyze secondary payer's coverage Review the secondary payer's benefit plan independently to determine if the service should be covered under their terms.
  4. Prepare a comprehensive appeal File an appeal with the secondary payer that includes the primary payer's denial, medical records, medical necessity documentation, and a letter explaining why the secondary payer should independently cover the service.
  5. Follow payer appeal process Submit the appeal through the secondary payer's designated appeal process.
  6. Monitor and follow up Track the appeal progress and provide additional information as requested.
Do Not Appeal This Code

Prior Payer Denied Services Not Covered by This Payer reflects a service that falls outside covered benefits, with the patient held responsible. Coverage decisions per plan terms generally aren't appealable in the traditional sense — the appropriate next step is verifying the patient was informed (ABN where applicable) and billing the patient if the determination is correct.

Also Filed As

The same CARC 276 may appear with different Group Codes:

CO-276 OA-276

Related Denial Codes

PR-26 — Expenses Incurred Prior to Coverage PR-27 — Expenses Incurred After Coverage Terminated PR-32 — Patient Not Eligible Dependent PR-33 — Insured Has No Dependent Coverage PR-34 — No Coverage for Newborns

Sources

  1. https://www.mdclarity.com/denial-code/276
  2. https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.