Denial · CARC 26
ELIGIBILITY · NORTHSTAR MUTUAL
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 | NORTHSTAR MUTUAL |
| Denial date | 5 Jul 2026 |
| Appeal deadline | 1 Jan 2027 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Modelled recovery is less than the cost of the work
The 835 reports CARC 26 on 5 Jul 2026, withholding $18.76 from the provider. The matched 834 shows coverage 13 May 2024 to open, which includes the service date of 14 May 2026. Modelled recoverable $18.76, less an estimated rework cost of $31.00, leaves -$12.24 net. The configured appeal window for this payer ends 1 Jan 2027, in 101 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. On these estimates the work costs more than it returns; that is a judgement about this model's figures, not a rule.
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 | 18.76 | withheld |