Denial · CARC 16
BILLING_ERROR · NORTHSTAR MUTUAL
Denied
428.00
Withheld
Recoverable
428.00
Realistically collectable
Net of rework
397.00
less 31.00
Appeal window
closed 683d 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 | NORTHSTAR MUTUAL |
| Denial date | 12 May 2024 |
| Appeal deadline | 8 Nov 2024 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Which team should investigate first?
Route first to Billing Related
The remittance carries CARC 16, and the claim was adjudicated by NORTHSTAR MUTUAL. The application maps CARC 16 to Billing Related using the originating-area reference. This class of denial is corrected by Billing Related rather than at registration. Check with that team before assuming a front-desk cause.
From: CARC 16 mapped to an owning department through the originating-area reference.
Limits: This is a routing recommendation, not a root-cause finding. The problem could arise from registration data, a later enrolment change, an interface mismatch, or the payer's own adjudication, and this mapping distinguishes none of them.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/16 | 428.00 | withheld |