Denial · CARC 26
ELIGIBILITY · CASCADE CARE
Classification
| Field | Value |
|---|---|
| Primary CARC | 26 |
| All CARCs | 26 |
| Root cause | ELIGIBILITY |
| Owns the fix | Access Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Expenses incurred prior to coverage. Check the enrolment span before 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
Appealable · $398.11 modelled net of rework
The 835 reports CARC 26 on 6 Oct 2025, withholding $429.11 from the provider. The matched 834 shows coverage 5 Nov 2024 to open, which includes the service date of 10 Jul 2025. Modelled recoverable $429.11, less an estimated rework cost of $31.00, leaves $398.11 net. The configured appeal window for this payer ends 6 Oct 2026, in 14 days. Recommended action: Expenses incurred prior to coverage. Check the enrolment span before appealing. Confirm the contractual deadline and any exception, reconsideration or correction route with the payer before closing the case.
From: Denial derivation: root cause, appealability, the recoverable amount net of an estimated rework cost, and a filing deadline derived from the denial date.
Limits: The deadline and the recoverable amount are application estimates. The deadline is the denial date plus a configured per-payer window, not a term read from the payer's contract or an appeal notice, and the recoverable figure is a model rather than a promise of payment. Confirm both against the policy before relying on them.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/26 | 429.11 | withheld |