Denial · CARC 11 — DenialIntel

Denials›CODING›claim B05M000613

Denial · CARC 11

CODING · NORTHSTAR MUTUAL

Denied

229.96

Withheld

Recoverable

229.96

Realistically collectable

Net of rework

198.96

less 31.00

Appeal window

101

Days left

Classification

Field	Value
Primary CARC	11
All CARCs	11
Root cause	CODING
Owns the fix	HIS
Appealable	yes
Recoverable	yes
Recommended action	Diagnosis inconsistent with procedure; review coding and resubmit.
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

Member Registrar Provider billing Denial analyst Director Payer review

What were we paid, and what can we still pursue?

$481.04 paid, $229.96 withheld

Billed $711.00. The payer paid $481.04, withheld $229.96. Of the $229.96 withheld, $229.96 is modelled as recoverable; less $31.00 to work it, that is $198.96 net. Diagnosis inconsistent with procedure; review coding and resubmit. To pursue the withheld amount, quote the payer's own claim number from the remittance and the adjudication date 5 Jul 2026, and confirm the route and deadline with the payer.

From: 835 CLP amounts and CAS adjustments on this claim; the denial derivation for the modelled recoverable amount and filing window.

Limits: Patient responsibility reported on an 835 is not revenue. This application cannot say whether the practice billed it, whether the patient paid, or whether a secondary payer covered it — those live in a billing system it does not read. The recoverable figure and the deadline are estimates, not a payer commitment.

Work this from the priority queue →

Adjustments

Level	Code	Amount	Counts as
line	PI/11	229.96	withheld