Denial · CARC 96
NON_COVERED · NORTHSTAR MUTUAL
Classification
| Field | Value |
|---|---|
| Primary CARC | 96 |
| All CARCs | 96 |
| Root cause | NON_COVERED |
| Owns the fix | Utilization |
| Appealable | yes |
| Recoverable | no |
| Recommended action | Non-covered charge. Read the RARC: some are appealable, most are not. |
| Payer | NORTHSTAR MUTUAL |
| Denial date | 22 Dec 2024 |
| Appeal deadline | 20 Jun 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 PRIYA GARCIA, the subscriber
The payer withheld $187.00 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. RARC N386: This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy. 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/96 | 187.00 | withheld |