Denial · CARC 11
CODING · NORTHSTAR MUTUAL
Denied
207.38
Withheld
Recoverable
207.38
Realistically collectable
Net of rework
176.38
less 31.00
Appeal window
closed 571d ago
Closed
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
Which team should investigate first?
Route first to HIS
The remittance carries CARC 11, and the claim was adjudicated by NORTHSTAR MUTUAL. The application maps CARC 11 to HIS using the originating-area reference. This class of denial is corrected by HIS rather than at registration. Check with that team before assuming a front-desk cause.
From: CARC 11 mapped to an owning department through the originating-area reference.
Limits: This is a routing recommendation, not a root-cause finding. The problem could arise from registration data, a later enrolment change, an interface mismatch, or the payer's own adjudication, and this mapping distinguishes none of them.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/11 | 207.38 | withheld |