Denial · CARC 26
ELIGIBILITY · MERIDIAN HEALTH PLAN
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 | MERIDIAN HEALTH PLAN |
| Denial date | 11 Feb 2024 |
| Appeal deadline | 11 May 2024 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
CARC 26 recurs across 1,875 denials
CARC 26 appears on 1,875 denials in the ingested corpus — 14.5% of 12,891 — carrying $849,079.18 withheld in total. By evidence result: dates consistent with the reason 1,455; record conflicts with the reason 315; reason and dates disagree 105. This volume warrants a management investigation across payers, services, locations and evidence results. The shared CARC does not yet establish a shared cause or a single corrective action.
From: Count and denied value of every denial sharing CARC 26, across the ingested remittances.
Limits: These are counts within the loaded corpus and its reporting period, not the full book of business. A shared reason code is recurrence, not a shared cause: the cases grouped here may arise from different payers, services and failures, and no department is implicated by the count alone.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/26 | 898.00 | withheld |