Denial · CARC 109
COB · NORTHSTAR MUTUAL
Denied
65.18
Withheld
Recoverable
65.18
Realistically collectable
Net of rework
34.18
less 31.00
Appeal window
closed 459d ago
Closed
Classification
| Field | Value |
|---|---|
| Primary CARC | 109 |
| All CARCs | 109 |
| Root cause | COB |
| Owns the fix | Access Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Not covered by this payer. Resubmit to the correct payer rather than appealing. |
| Payer | NORTHSTAR MUTUAL |
| Denial date | 22 Dec 2024 |
| Appeal deadline | 20 Jun 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Does this mean I owe money?
The care was for WENDY TANAKA, the subscriber
The payer withheld $65.18 from the provider for this service. The 835 did not assign any of this adjustment to the patient, so nothing here was reported as the member's responsibility. Do not treat the denied amount as a patient bill on the strength of this remittance alone. If a bill arrives for it, ask the provider what correction or appeal is under way, and question any balance the remittance does not support.
From: 835 CAS adjustment group codes on this remittance; the 837P patient loop that identifies who was treated.
Limits: This says what the 835 reported, not what was billed. A later remittance, a secondary payer or a correction can each change what the member is asked to pay, and none of that is visible here.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/109 | 65.18 | withheld |