Denial · CARC 50
MEDICAL_NECESSITY · NORTHSTAR MUTUAL
Denied
154.00
Withheld
Recoverable
154.00
Realistically collectable
Net of rework
123.00
less 31.00
Appeal window
closed 739d ago
Closed
Classification
| Field | Value |
|---|---|
| Primary CARC | 50 |
| All CARCs | 50 |
| Root cause | MEDICAL_NECESSITY |
| Owns the fix | Utilization |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Not deemed medically necessary. Appeal with clinical documentation. |
| Payer | NORTHSTAR MUTUAL |
| Denial date | 17 Mar 2024 |
| Appeal deadline | 13 Sep 2024 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Is the available evidence consistent with the stated reason?
No independent evidence for this reason
CARC 50 is not one this data can test. The cross-checks cover coverage assertions, against the 834, and authorisation assertions, against the 278. For every other reason the payer's statement stands unexamined here.
From: The CARC on this remittance, and the cross-checks available.
Limits: Absence of contradicting evidence is not agreement. This says only that the application holds no record able to test the assertion — not that the denial is correct.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/50 | 154.00 | withheld |