Denial · CARC 27
ELIGIBILITY · NORTHSTAR MUTUAL
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 | 28 Sep 2025 |
| Appeal deadline | 27 Mar 2026 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
The modelled appeal window passed 179 days ago
The 835 reports CARC 27 on 28 Sep 2025, withholding $571.00 from the provider. The matched 834 shows coverage 24 Apr 2024 to open, which includes the service date of 13 Aug 2025. Modelled recoverable $571.00, less an estimated rework cost of $31.00, leaves $540.00 net. The configured appeal window for this payer ends 27 Mar 2026, 179 days ago. 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. 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/27 | 571.00 | withheld |