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 | 16 Mar 2025 |
| Appeal deadline | 12 Sep 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
The care was for DAVID ANDERSON, the subscriber
The payer withheld $614.00 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/26 | 614.00 | withheld |