Denial · CARC 27
ELIGIBILITY · NORTHSTAR MUTUAL
Denied
479.00
Withheld
Recoverable
479.00
Realistically collectable
Net of rework
448.00
less 31.00
Appeal window
closed 109d ago
Closed
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 | NORTHSTAR MUTUAL |
| Denial date | 7 Dec 2025 |
| Appeal deadline | 5 Jun 2026 |
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?
Coverage dates are consistent with the stated reason
The payer asserts a coverage problem under CARC 27, and the matched 834 is consistent with it: coverage ended 28 Sep 2025, before the service on 3 Nov 2025.
From: 835 CARC against the matched 834 enrolment span.
Limits: Consistent dates are not a finding that the denial is correct. This application holds no payer adjudication snapshot, plan rules or enrolment change history, so it cannot say whether the service should have been eligible under another provision, nor rule out a retroactive update the payer has since received.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/27 | 479.00 | withheld |