Denial · CARC 96
NON_COVERED · MERIDIAN HEALTH PLAN
Classification
| Field | Value |
|---|---|
| Primary CARC | 96 |
| All CARCs | 96,45 |
| 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 | MERIDIAN HEALTH PLAN |
| Denial date | 28 Sep 2025 |
| Appeal deadline | 27 Dec 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Nothing withheld — $279.50 now rests with the patient
Billed $430.00. The payer paid $0.00, wrote off $150.50 under the contract, and assigned $279.50 to the patient. The $150.50 contractual write-off is not collectable from anyone — it is the discount the practice agreed with this payer. Nothing is modelled as recoverable from the payer: it withheld nothing on this claim. Non-covered charge. Read the RARC: some are appealable, most are not. Before billing the patient, confirm the balance against the remittance, check whether notice was given before the service, and check whether a secondary payer applies.
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.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PR/96 | 279.50 | write-off |
| line | CO/45 | 150.50 | write-off |