CARC 286 Active

PR-286: Appeal Time Limits Not Met

TL;DR

Your appeal was rejected because it was filed after the payer's deadline. Check if a good cause exception or second-level appeal with a different deadline is available. Going forward, implement deadline tracking to prevent future missed appeal windows.

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-286 Mean?

CARC 286 means the payer rejected your appeal because it was not filed within the required timeframe. Payers establish specific deadlines for appeals — typically ranging from 60 to 180 days from the date of the initial denial, depending on the payer and plan type. Medicare generally allows 120 days for a redetermination request.

This code represents a procedural failure rather than a clinical or coverage determination. The payer is not saying your appeal lacks merit — it is saying the appeal arrived too late to be considered through the standard process.

The most common causes are delayed identification of denials requiring appeal, internal workflow bottlenecks that slow down documentation gathering and appeal preparation, and misunderstanding of the appeal deadline calculation (starting from the wrong date). Some payers allow good cause exceptions for missed deadlines, and external review or second-level appeal processes may have different timelines.

How to Resolve

Verify the deadline has truly passed, check for good cause exceptions or alternative appeal routes, and implement tracking to prevent future misses.

  1. Verify the deadline Review the denial letter to confirm the appeal deadline and verify it has truly passed. Check whether the deadline is calculated from the date of the denial letter or the date of receipt.
  2. Check for good cause exceptions Determine if the payer allows good cause exceptions for late appeals. If so, prepare documentation of extenuating circumstances that caused the delay.
  3. Explore alternative appeal routes Check if the payer offers a second-level or external review process with different deadlines that may still be available.
  4. Prepare a late appeal with justification If a good cause exception is available, file the appeal with a cover letter explaining the reason for the delay and providing documentation of extenuating circumstances.
  5. Submit the appeal File the appeal with a request for good cause exception through the payer's designated submission process.
  6. Escalate if necessary If the deadline was missed due to payer error (e.g., delayed notification), escalate to a supervisor or legal counsel.
Do Not Appeal This Code

Appeal Time Limits Not Met grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

Also Filed As

The same CARC 286 may appear with different Group Codes:

CO-286 OA-286

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://www.mdclarity.com/denial-code/286
  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.