Denial · CARC 26
ELIGIBILITY · CASCADE CARE
Denied
551.00
Withheld
Recoverable
551.00
Realistically collectable
Net of rework
520.00
less 31.00
Appeal window
134
Days left
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 | CASCADE CARE |
| Denial date | 3 Feb 2026 |
| Appeal deadline | 3 Feb 2027 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Is the available evidence consistent with the stated reason?
Coverage record conflicts with the stated reason
The payer asserts a coverage problem under CARC 26. The matched 834 shows coverage from 26 Dec 2024 to open, which includes the service date of 12 Oct 2025. The payer would need to re-check the eligibility source it adjudicated against.
From: 835 CARC against the matched 834 enrolment span.
Limits: A coverage span is not a final benefit determination. A retroactive termination, a plan rule or a different eligibility feed on the payer's side could each explain the difference, and none of them is visible here.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/26 | 551.00 | withheld |