Denial · CARC 16
BILLING_ERROR · MERIDIAN HEALTH PLAN
Denied
260.00
Withheld
Recoverable
260.00
Realistically collectable
Net of rework
229.00
less 31.00
Appeal window
closed 710d ago
Closed
Classification
| Field | Value |
|---|---|
| Primary CARC | 16 |
| All CARCs | 16 |
| Root cause | BILLING_ERROR |
| Owns the fix | Billing Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Claim lacks information. Read the accompanying RARC for what is missing. |
| Payer | MERIDIAN HEALTH PLAN |
| Denial date | 14 Jul 2024 |
| Appeal deadline | 12 Oct 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 16 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/16 | 260.00 | withheld |