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Clarity Flow
Accurate patient cost estimate software that stimulates upfront payments and complies with price transparency regulations.
RevFind
Underpayment detection and contract optimization software that ingests your contract terms and identifies opportunities for net revenue uplift when payers stiff you.
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Detect Underpayments
Identify revenue opportunities from payer underpayments down to the claim level.
Increase Upfront Collections
Avoid write-offs by collecting from patients earlier in the AR cycle.
Comply with Good Faith Estimates
Automate creation and delivery of accurate patient estimates to adhere to transparency rules.
Evaluate Contract Performance
Measure and compare managed care contract performance for better negotiation outcomes.
Optimize Your Chargemaster
Correct chargemaster rates that fall short of contracted rates to maximize revenue.
Automate Eligibility Checks
Fix the leading cause of denials by automating insurance eligibility verification.
Manage Denials
Jumpstart your appeals and denials prevention processes by automating denials management.
Model Potential Contract Rate Changes
Model the impact of contract proposals on revenue during negotiations with payers.
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Denial Code (CARC) List
Overwhelmed by CARCs? Get up to speed with our list of denial codes.
CARC #
Claim Adjustment Reason Code Description
1
Denial code 1 is for Deductible Amount. It means the patient needs to pay a certain amount before insurance coverage kicks in.
10
Denial code 10 means the diagnosis doesn't match the patient's gender. Check the 835 Healthcare Policy Identification Segment for more details.
100
Denial code 100 is when the payment is made directly to the patient, insured, or responsible party instead of the healthcare provider.
101
Denial code 101 is for predetermination, which means the payment is expected after services or claim processing.
102
Denial code 102 is a Major Medical Adjustment that indicates a claim has been denied or adjusted due to a significant medical reason.
103
Denial code 103 is when a healthcare provider's promotional discount, like a senior citizen discount, is not accepted by the insurance company.
104
Denial code 104 is when a managed care organization withholds payment for a healthcare service.
105
Denial code 105 is for tax withholding. Learn why this code may be affecting your healthcare revenue cycle management.
106
Denial code 106 is when the patient's chosen payment option is not in effect.
107
Denial code 107 means the claim doesn't have the necessary information to link it to the related service. Check the 835 Healthcare Policy Identification Segment for more details.
108
Denial code 108 means the guidelines for renting or purchasing were not followed. Check the 835 Healthcare Policy Identification Segment for more information.
109
Denial code 109 is when the claim or service is not covered by the payer/contractor. You need to send it to the right one.
11
Denial code 11 means the diagnosis doesn't match the procedure. Check the 835 Healthcare Policy Identification Segment for more details.
110
Denial code 110 is when the billing date is before the service date.
111
Denial code 111 is when a service is not covered unless the provider accepts assignment.
112
Denial code 112 is when the service was not provided directly to the patient and/or not properly documented.
114
Denial code 114 is when a procedure or product is not approved by the FDA.
115
Denial code 115 means that a medical procedure was postponed, canceled, or delayed. Find out why and how to resolve it for proper reimbursement.
116
Denial code 116 is when the patient's advance indemnification notice doesn't meet the necessary requirements.
117
Denial code 117 means transportation is only covered to the closest facility that can provide the necessary care.
118
Denial code 118 is for ESRD network support adjustment. Learn why your healthcare provider may have received this denial code and how to address it.
119
Denial code 119 means the maximum benefit for this time period or occurrence has been reached.
12
Denial code 12 means the diagnosis doesn't match the provider type. Check the 835 Healthcare Policy Identification Segment for more details.
121
Denial code 121 is an adjustment made to compensate for any outstanding member responsibility in healthcare billing.
122
Denial code 122 is a reduction in payment for psychiatric services. Understand why this code is important for healthcare providers and how to address it.
128
Denial code 128: Newborn's services are covered in the mother's Allowance.
129
Denial code 129 is when there is incorrect prior processing information. At least one Remark Code must be provided.
13
Denial code 13 means the date of death comes before the date of service.
130
Denial code 130 is for claim submission fee. Learn why your healthcare provider may receive this denial code and how to avoid it.
131
Denial code 131 is when a claim is denied because it includes a negotiated discount that is specific to that claim.
132
Denial code 132 is a prearranged demonstration project adjustment that may affect healthcare provider's revenue cycle management.
133
Denial code 133 is a temporary status for a healthcare service that is under review. It requires correction once the review is complete.
134
Denial code 134 is when technical fees are taken out from the charges.
135
Denial code 135 is when interim bills cannot be processed.
136
Denial code 136 is for failure to follow prior payer's coverage rules. It is used with Group Code OA.
137
Denial code 137 is for regulatory surcharges, assessments, allowances, or health-related taxes that were not approved for reimbursement.
139
Denial code 139 is for a contracted funding agreement where the subscriber is employed by the provider of services. Use with Group Code CO.
14
Denial code 14 means the patient's date of birth is after the date of service.
140
Denial code 140 is when the patient's or insured's health identification number and name do not match.
142
Denial code 142 is for the monthly Medicaid patient liability amount.
143
Denial code 143 is when a portion of the payment is deferred, meaning it is not immediately approved or paid by the insurance company.
144
Denial code 144 is an incentive adjustment, like a preferred product or service, that has been denied for reimbursement.
146
Denial code 146 means the diagnosis reported for the service date(s) was not valid.
147
Denial code 147 is when the provider's negotiated rate has expired or is not on file.
148
Denial code 148 means that the information from another provider was not given or was incomplete. At least one remark code must be provided.
149
Denial code 149: Lifetime benefit max reached for this service/benefit category. Understand why your healthcare claim was denied.
150
Denial code 150 is when the payer believes the information provided does not justify the level of service.
151
Denial code 151 is when the payer believes that the information provided does not justify the number or frequency of services.
152
Denial code 152 means the payer doesn't think the information provided justifies the length of service. Check the 835 Healthcare Policy Identification Segment for more details.
153
Denial code 153 is when the payer believes that the information provided does not justify the prescribed dosage.
154
Denial code 154 is when the payer determines that the information provided does not justify the amount of medication or supplies for that day.
155
Denial code 155 is when the patient refuses the service or procedure.
157
Denial code 157 is when a service or procedure is denied because it was provided due to an act of war.
158
Denial code 158 is when the service/procedure was provided outside of the United States.
159
Denial code X is "Service/procedure provided due to terrorism." Understand why healthcare providers may face denials related to this unique circumstance.
16
Denial code 16 is for claims with missing or incorrect information. A remark code must be provided. Do not use for attachments or documentation.
160
Denial code X is for injuries/illnesses caused by activities not covered by insurance.
161
Denial code 161 is a provider performance bonus that has been denied for reimbursement.
163
Denial code 163 means that the requested documents for the claim were not received.
164
Denial code 164 is when the required documents for a claim were not received on time.
166
Denial code 166 is when services are submitted after the payer's responsibility for processing claims under the plan has ended.
167
Denial code 167 means the diagnosis is not covered. Check the 835 Healthcare Policy Identification Segment for more information.
169
Denial code 169: Alternate benefit has been provided. Understand why your healthcare claim was denied and how to resolve it.
170
Denial code 170 means payment is denied for services provided by this type of provider. Refer to the 835 Healthcare Policy Identification Segment for more information.
171
Denial code 171 means payment is denied for services provided by a specific type of provider in a specific type of facility. Check the 835 Healthcare Policy Identification Segment for more information.
172
Denial code 172 means payment is adjusted for services performed by a provider of a specific specialty. Check the 835 Healthcare Policy Identification Segment for more details.
173
Denial code 173 is when a physician did not prescribe the service or equipment.
174
Denial code 174 is when the service was not prescribed before it was delivered.
175
Denial code 175 is for an incomplete prescription.
176
Denial code 176: Prescription is not current. Understand why healthcare providers may face this issue and how to address it effectively.
177
Denial code 177: Patient has not met the required eligibility requirements. Simplify your healthcare revenue cycle management with our expert guidance.
178
Denial code 178: Patient has not met spend down requirements. Understand why insurance claims are denied & how to resolve them. Expert healthcare revenue cycle management advice.
179
Denial code 179 means the patient hasn't fulfilled the waiting requirements. Check the 835 Healthcare Policy Identification Segment for more details.
18
Denial code 18 is for an exact duplicate claim or service. It is used with Group Code OA, except in cases where state workers' compensation regulations require CO.
180
Denial code 180 is when the patient does not meet the necessary residency requirements.
181
Denial code 181 is when the procedure code used was not valid on the date of service.
182
Denial code 182 is when the procedure modifier used on the date of service is not valid.
183
Denial code 183 means the referring provider is not authorized to refer the service billed. Check the 835 Healthcare Policy Identification Segment for more details.
184
Denial code 184 means the provider is not authorized to prescribe the service. Check the 835 Healthcare Policy Identification Segment for more details.
185
Denial code 185 means the provider is not allowed to perform the service billed. Check the 835 Healthcare Policy Identification Segment for more details.
186
Denial code 186 is a level of care change adjustment that may result in a claim being denied by insurance companies.
187
Denial code 187 is for Consumer Spending Account payments, like Flexible Spending Account or Health Savings Account, that were not approved.
188
Denial code 188 is when a product or procedure is not covered unless it is used as recommended by the FDA.
189
Denial code 189 means a procedure code was billed that doesn't have a specific code for that service.
19
Denial code 19 is when the insurance company denies payment because they believe the injury or illness is related to work and should be covered by Worker's Compensation.
190
Denial code 190 means payment is already covered for a qualified stay at a Skilled Nursing Facility (SNF).
192
Denial code 192 is a non-standard adjustment code used by providers/payers to provide Coordination of Benefits information to another payer. It is used when the non-standard code cannot be mapped to an existing Claims Adjustment Reason Code for Deductible, Coinsurance, and Co-payment.
193
Denial code 193 is when the original payment decision is being maintained because the claim was processed correctly.
194
Denial code 194 is for anesthesia performed by the operating physician, assistant surgeon, or attending physician.
195
Denial code 195 is when a refund is mistakenly given to the wrong payer for a claim or service.
197
Denial code 197 is when precertification/authorization/notification/pre-treatment is missing.
198
Denial code 198 is when the precertification, notification, authorization, or pre-treatment requirements have been exceeded.
199
Denial code 199 is when the revenue code and procedure code don't match, causing a claim to be rejected by the insurance company.
2
Denial code 2 is for coinsurance amount. It refers to the portion of the medical bill that the patient is responsible for paying after their insurance has paid its share.
20
Denial code 20: Injury/illness covered by liability carrier. Understand why your healthcare claim was denied.
200
Denial code 200 is when expenses are not covered due to a lapse in insurance coverage.
201
Denial code 201 means the patient is responsible for the claim amount due to an agreement. A remark code must be provided. #healthcarerevenue #denialcode
202
Denial code 202 is for services that are not covered by insurance, such as personal comfort or convenience services.
203
Denial code 203 is when a healthcare provider's claim is rejected because the service was discontinued or reduced.
204
Denial code 204 is when a service, equipment, or drug is not covered by the patient's insurance plan.
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