CARC P11 Active

PR-P11: P&C Claim Disposition Pending Due to Litigation

TL;DR

The P&C claim disposition is pending due to active litigation. The medical claim cannot be finalized until the underlying legal case resolves. Redirect to health insurance in the interim.

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-P11 Mean?

CARC P11 is closely related to P10 but has a subtle distinction: while P10 indicates payment was reduced to zero, P11 specifically indicates the P&C claim disposition itself is pending because of litigation. The medical claim is in limbo because the underlying P&C claim has not been resolved due to ongoing legal proceedings — liability may still be in dispute, a previous determination is being appealed, or the P&C case itself is being litigated.

The practical effect is the same as P10: the carrier cannot process the medical claim until the legal matter is resolved. Redirect billing to health insurance in the interim.

How to Resolve

Redirect to health insurance in the interim, track the litigation, and rebill P&C after resolution.

  1. Contact the adjuster Get details on the litigation status, expected timeline, and the specific legal dispute affecting the claim.
  2. Redirect to health insurance Bill the patient's health insurance while the P&C litigation is pending.
  3. Track the litigation Monitor the P&C claim litigation for resolution and payment timeline.
  4. Rebill P&C after resolution Once litigation resolves, rebill the P&C carrier if the outcome supports coverage.
Do Not Appeal This Code

The P&C claim disposition is pending due to active litigation. The medical claim cannot be finalized until the litigation resolves. Bill the patient's health insurance in the interim.

Also Filed As

The same CARC P11 may appear with different Group Codes:

CO-P11 OA-P11

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://www.cms.gov/medicare/coordination-benefits
  3. Codes maintained by X12. Visit x12.org for official definitions.