Denial · CARC 26
ELIGIBILITY · CASCADE CARE
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 | CASCADE CARE |
| Denial date | 5 Dec 2025 |
| Appeal deadline | 5 Dec 2026 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
$368.00 withheld, nothing paid
Billed $368.00. The payer paid $0.00, withheld $368.00. Of the $368.00 withheld, $368.00 is modelled as recoverable; less $31.00 to work it, that is $337.00 net. Expenses incurred prior to coverage. Check the enrolment span before appealing. To pursue the withheld amount, quote the payer's own claim number from the remittance and the adjudication date 5 Dec 2025, and confirm the route and deadline with the payer.
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 | PI/26 | 368.00 | withheld |