Denial · CARC 27
ELIGIBILITY · CASCADE CARE
Classification
| Field | Value |
|---|---|
| Primary CARC | 27 |
| All CARCs | 27 |
| Root cause | ELIGIBILITY |
| Owns the fix | Access Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Expenses incurred after coverage terminated. Check the enrolment span: if the member was covered on the service date this is wrongly denied and worth appealing. |
| Payer | CASCADE CARE |
| Denial date | 6 Oct 2025 |
| Appeal deadline | 6 Oct 2026 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
$886.00 withheld, nothing paid
Billed $886.00. The payer paid $0.00, withheld $886.00. Of the $886.00 withheld, $886.00 is modelled as recoverable; less $31.00 to work it, that is $855.00 net. Expenses incurred after coverage terminated. Check the enrolment span: if the member was covered on the service date this is wrongly denied and worth appealing. To pursue the withheld amount, quote the payer's own claim number from the remittance and the adjudication date 6 Oct 2025, and confirm the route and deadline with the payer.
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/27 | 886.00 | withheld |