Denial · CARC 26
ELIGIBILITY · MERIDIAN HEALTH PLAN
Denied
132.06
Withheld
Recoverable
132.06
Realistically collectable
Net of rework
101.06
less 31.00
Appeal window
closed 507d ago
Closed
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 | MERIDIAN HEALTH PLAN |
| Denial date | 2 Feb 2025 |
| Appeal deadline | 3 May 2025 |
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 20 Oct 2024 to 24 Jan 2025, which includes the service date of 20 Dec 2024. 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 | 132.06 | withheld |