CARC & RARC Denial Code Directory
Instant root causes, step-by-step resolution checklists, and proven appeal templates for top medical billing claim denials.
Missing Information or Billing Error
Claim/service lacks information or has submission/billing error(s)
Service Inconsistent with Policy/POS
Service inconsistent with payer policy/procedure and/or not appropriate for place of service
Timely Filing Limit Expired
Claim submitted past the payer contractual timely filing deadline
Not Medically Necessary
Non-covered services — not deemed a medical necessity under payer policy
Charge Exceeds Fee Schedule
Charge exceeds fee schedule / maximum allowable amount (Contractual Adjustment)
Bundled into Primary Service
Benefit included in another service / bundled procedure (NCCI edit)
Prior Authorization Absent
Precertification/authorization/notification absent or invalid
Non-Covered Benefit Exclusion
Service/equipment/drug is not covered under patient's current benefit plan
Duplicate Claim / Service
Exact duplicate claim/service previously billed or paid
Coordination of Benefits / Other Payer
Payment adjusted because care may be covered by another primary insurer
Expenses Incurred After Termination
Patient insurance coverage was terminated prior to date of service
Payment Adjusted / Downcoded E/M
Information submitted does not support the billed level of service
Deductible Amount
Patient annual deductible amount applied
Coinsurance Amount
Patient percentage coinsurance amount applied
Co-payment Amount
Patient fixed copayment amount applied
No denial codes found
Try searching for a different code number (e.g. CO-16) or clear the filter.
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