Denial · CARC 16
BILLING_ERROR · MERIDIAN HEALTH PLAN
Denied
126.87
Withheld
Recoverable
126.87
Realistically collectable
Net of rework
95.87
less 31.00
Appeal window
closed 640d 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 | MERIDIAN HEALTH PLAN |
| Denial date | 22 Sep 2024 |
| Appeal deadline | 21 Dec 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 MERIDIAN HEALTH PLAN. 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 | 126.87 | withheld |