CARC P8 Active

PR-P8: Claim Under Investigation — P&C Only

TL;DR

The P&C claim is under investigation and payment is withheld. Cooperate with the investigation, respond to information requests, and redirect to health insurance in the interim. If the investigation results in a denial, appeal through the carrier's formal process.

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-P8 Mean?

CARC P8 applies to property and casualty claims and indicates the claim is under investigation, with payment withheld pending the outcome. The investigation may involve potential fraud review, liability determination, Special Investigation Unit (SIU) referral, or subrogation investigation to determine if another party is liable.

This is a hold status, not a final denial. Payment may be released once the investigation concludes favorably. The provider should cooperate fully with the investigation, respond promptly to requests for information, and consider billing the patient's health insurance in the interim if the investigation is expected to take an extended period.

How to Resolve

Cooperate with the investigation, respond to information requests, and redirect to health insurance in the interim.

  1. Contact the P&C adjuster Request details about the investigation, including the reason, expected timeline, and what information is needed.
  2. Respond to information requests Provide any requested documentation promptly to minimize the investigation duration.
  3. Redirect to health insurance If the investigation is expected to take months, consider billing the patient's health insurance in the interim.
  4. Monitor investigation status Follow up regularly on the investigation progress.
  5. Appeal if denied after investigation If the investigation results in a denial, appeal through the carrier's formal process with documentation supporting the claim's legitimacy.
Do Not Appeal This Code

Claim Under Investigation — P&C Only 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 P8 may appear with different Group Codes:

CO-P8 OA-P8

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.