Billing — Rejections
Rejection triage by CARC/RARC codes and denial reason (flow Step 5). Resolve and resubmit are money-actions.
Rejection triage by CARC/RARC codes and denial reason (flow Step 5). Resolve and resubmit are money-actions.
| Action | |||||||
|---|---|---|---|---|---|---|---|
| 233cae7d-e36f-492a-a038-4d1956ef2610 | UHC/UBH/Optum-FL | denied | CARC PR-227 · RARC N479 | UNKNOWN; Info Requested from Patient | — | 97155 | |
| 26017b1c-f322-4056-a095-2f133578c2ae | BCBS TX MCO | denied | CARC OA-18 | Duplicate Claim | Billing — combine units CARC 18 | 97155 | |
| 2ea4d5ae-b5d8-4578-a408-dfcff25b87aa | Partnership HealthPlan of California | denied | CARC CO-4 | Invalid Modifier | Billing — fix in Candid CARC 4 | 97155, 97156 | |
| 42098c64-6944-4977-87ff-765e336395b4 | Partnership HealthPlan of California | denied | CARC CO-4 | Invalid Modifier | Billing — fix in Candid CARC 4 | 97153, 97156, 97153, 97155 | |
| 4352085d-5bf7-49a5-9add-6bafed586dfb | Health Plan of San Mateo | denied | CARC CO-197 | Authorization Required | Auth team CARC 197 | H0046, S5111 | |
| 45bc1680-8d67-4bf3-8889-fda44d73e4ca | UHC Community Plan | denied | CARC CO-96 · RARC N188 | Non-Covered Benefit | VOB team CARC 96 | 97153 | |
| 48cbdf4a-ef99-466b-838c-381150cb9896 | Cigna-TX | denied | CARC CO-119, OA-94, PI-97, CO-45, PR-2 · RARC N130, N362 | Max Benefit Reached | VOB team CARC 119 | 97151 | |
| 5117ccbe-57b1-455b-b2f9-36901fa67e07 | Texas Children's Health Plan MCO-TX | denied | CARC CO-18, CO-45 · RARC N522 | Duplicate Claim | Billing — combine units CARC 18 | 97155, 97156 | |
| 53f6d286-e870-4973-ae36-a344a281a0ca | Superior Health Plan-TX | denied | CARC CO-216 · RARC N880 | Billing Error | — | 97153, 97153, 97153 | |
| 54056043-4b43-4224-918f-4c02d2fae23e | UHC Community Plan | denied | CARC CO-B7 | Credentialing | Credentialing team CARC B7 | 97153 | |
| 5bf2f913-0a08-42d3-935b-18984d69f7a3 | Partnership HealthPlan of California | denied | CARC CO-4 | Invalid Modifier | Billing — fix in Candid CARC 4 | 97156 | |
| 5c7a8b7e-7d30-4dd3-865d-c42ae9f04aa6 | Texas Children's Health Plan MCO-TX | denied | CARC CO-B7 · RARC N767 | Credentialing | Credentialing team CARC B7 | 97153, 97153 | |
| 6df69e07-bb66-4d48-9659-18e9d7d14c0c | Molina-CA-SCA | denied | CARC CO-B7, CO-206 · RARC N570, N257 | Credentialing; Invalid Provider Information | Credentialing team CARC B7 | S5111, H0046 | |
| 7b7200f5-03b4-4456-9e77-800b7942cde7 | UHC/UBH/Optum-CA | denied | CARC PI-252 · RARC N453, N220, N221, N457 | Info Requested from Provider | — | 97155, 97155 | |
| 821f12d6-7bb6-4532-b572-74c67b163351 | BCBS OF TX | denied | CARC CO-96 · RARC N10 | Non-Covered Benefit | VOB team CARC 96 | 97153 | |
| 86ecc710-0174-48dd-bd85-5d2ea16dd45c | Superior Health Plan-TX | denied | CARC CO-119, CO-216, CO-45 · RARC N587, N880 | Max Benefit Reached | VOB team CARC 119 | 97153 | |
| 87b60266-3f9e-4418-94ff-a9e9a03abf3d | UHC/UBH/Optum-FL | denied | CARC CO-197 | UNKNOWN; Authorization Required | Auth team CARC 197 | 97153 | |
| 884311a1-c643-4f25-83a2-f78e2c02b8f1 | UHC/UBH/Optum-NJ | rejected | CARC CO-45, PR-3 | DUPLICATE_CLAIM; Full Contractual Adjustment | Billing — combine units text: duplicate claim | 97153, 97153 | |
| 8b9c205f-6a83-4d14-8741-e042129019cc | Partnership HealthPlan of California | denied | CARC CO-4 | Invalid Modifier | Billing — fix in Candid CARC 4 | 97153 | |
| 8df3406f-1968-426e-8e41-9c3418155b2d | Superior Health Plan-TX | denied | CARC CO-119 · RARC N362 | Max Benefit Reached | VOB team CARC 119 | 97155 | |
| 94251124-e142-47b9-beeb-82ebeb0287cf | Partnership HealthPlan of California | denied | CARC CO-4 | Invalid Modifier | Billing — fix in Candid CARC 4 | 97156 | |
| 94f9de93-4e91-45c7-b9a6-330bf7e61f19 | UHC/UBH/Optum-FL | denied | CARC CO-197 | UNKNOWN; Authorization Required | Auth team CARC 197 | 97155 | |
| 957b3330-6b20-43f3-9e0e-93fe23a12bd8 | Aetna-NJ | denied | CARC CO-B13 | Duplicate Claim | Billing — combine units text: duplicate claim | 97155, 97155 | |
| 97a1211b-e093-4bd8-b9df-63f3f7b9ee0f | Molina-CA-SCA | denied | CARC CO-206 · RARC N257 | Invalid Provider Information | — | H0046 | |
| 9a2e474e-d377-4eec-aa2c-236ff901bc63 | BCBS OF TX | denied | CARC OA-23, PR-2, CO-45 | Full Contractual Adjustment | Payment Posting CARC 23 | 97155 |
0 of 200 row(s) selected.