Denial · CARC 109
COB · MERIDIAN HEALTH PLAN
Classification
| Field | Value |
|---|---|
| Primary CARC | 109 |
| All CARCs | 109 |
| Root cause | COB |
| Owns the fix | Access Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Not covered by this payer. Resubmit to the correct payer rather than appealing. |
| Payer | MERIDIAN HEALTH PLAN |
| Denial date | 22 Sep 2024 |
| Appeal deadline | 21 Dec 2024 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
$257.94 paid, $66.06 withheld
Billed $324.00. The payer paid $257.94, withheld $66.06. Of the $66.06 withheld, $66.06 is modelled as recoverable; less $31.00 to work it, that is $35.06 net. Not covered by this payer. Resubmit to the correct payer rather than appealing. The modelled filing window closed 640 days ago. Confirm the contractual deadline before deciding whether a late submission or reconsideration is still open.
From: 835 CLP amounts and CAS adjustments on this claim; the denial derivation for the modelled recoverable amount and filing window.
Limits: Patient responsibility reported on an 835 is not revenue. This application cannot say whether the practice billed it, whether the patient paid, or whether a secondary payer covered it — those live in a billing system it does not read. The recoverable figure and the deadline are estimates, not a payer commitment.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/109 | 66.06 | withheld |