CARC B11 Active

PR-B11: Claim Transferred to Proper Payer — Not Covered Here

TL;DR

PR-B11 means no payer accepted the claim after transfer, leaving the patient responsible. Verify all insurance options before collecting.

Action
Collect from Patient
Who Pays
Patient
Appeal
Yes
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-B11 Mean?

When paired with Group Code PR, the claim was transferred but no payer accepted coverage, leaving the patient responsible. This may occur when the patient's insurance has lapsed with all identified payers. Verify coverage status before collecting from the patient.

CARC B11 indicates the payer received the claim but determined it is not the correct payer for this patient or service. The payer transferred the claim to what it identified as the proper payer for processing. This is a routing issue — the claim was sent to the wrong destination.

Common causes include submitting to a payer where the patient's coverage has terminated, incorrect Medicare Secondary Payer routing, outdated insurance information, or simple claim submission errors. The payer may have automatically forwarded the claim, or it may simply be informing you that the claim needs to go elsewhere.

The primary action is to verify the patient's current insurance information and ensure the claim reaches the correct payer. If the payer says it transferred the claim, follow up with the receiving payer to confirm it was received and is being processed.

Common Causes

Cause Frequency
No other coverage available The claim was transferred but no payer accepted coverage, leaving the patient responsible Common
Patient coverage lapsed The patient's insurance with all identified payers has lapsed, resulting in patient responsibility Occasional

How to Resolve

  1. Verify all insurance options Confirm the patient's coverage status with all known payers.
  2. Appeal if coverage exists If active insurance is found, redirect the claim to the correct payer.
  3. Collect from patient if no coverage If no active insurance exists, inform the patient of their responsibility.
Appeal Guide

Appeal with documentation of the patient's active insurance coverage to redirect financial responsibility to the correct payer.

How to Prevent PR-B11

Also Filed As

The same CARC B11 may appear with different Group Codes:

CO-B11 OA-B11

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://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/b11
  3. https://www.cms.gov/regulations-and-guidance/guidance/manuals
  4. Codes maintained by X12. Visit x12.org for official definitions.