Denial Resolution Search
Search by selecting categories Claim Adjustment Reason Codes (CARC) or Remittance Advice Remark Codes (RARC) and the corresponding code below.
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Search by selecting categories Claim Adjustment Reason Codes (CARC) or Remittance Advice Remark Codes (RARC) and the corresponding code below.
Reason | Corrective Action |
|---|---|
New patient billed when patient has already received care from the provider | Claim correction to change procedure code to established patient |
If a provider disagrees with a payment determination and a claim correction is not the next step, request a Reconsideration using the Appeal form.
A reconsideration is not an appeal as it’s a payment dispute and not an adverse benefit determination; it does not use the member’s appeal rights. A reconsideration of a payment determination is a provider right only. When completing the appeal form, select Provider on behalf of self.
Providers will receive a reconsideration notification within 45 days of receipt of the request. If a provider disagrees with the determination, they will have the option of requesting a second reconsideration within 45 days. Providers will receive a reconsideration notification of their subsequent request within 45 days of receipt of the request.