Denial · CARC 11
CODING · NORTHSTAR MUTUAL
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 | 1 Sep 2024 |
| Appeal deadline | 28 Feb 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
CARC 11 recurs across 658 denials
CARC 11 appears on 658 denials in the ingested corpus — 5.1% of 12,891 — carrying $234,070.01 withheld in total. This volume warrants a management investigation across payers, services, locations and evidence results. The shared CARC does not yet establish a shared cause or a single corrective action. Split these cases by evidence result before choosing an intervention, then compare by payer, specialty, location and period.
From: Count and denied value of every denial sharing CARC 11, across the ingested remittances.
Limits: These are counts within the loaded corpus and its reporting period, not the full book of business. A shared reason code is recurrence, not a shared cause: the cases grouped here may arise from different payers, services and failures, and no department is implicated by the count alone.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/11 | 207.38 | withheld |