Denial · CARC 26 — DenialIntel

Denials›ELIGIBILITY›claim B06M000621

Denial · CARC 26

ELIGIBILITY · MERIDIAN HEALTH PLAN

Denied

126.89

Withheld

Recoverable

126.89

Realistically collectable

Net of rework

95.89

less 31.00

Appeal window

Days left

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	9 Aug 2026
Appeal deadline	7 Nov 2026

Denial workflow

Field	Value
Current status	new
Appeal outcome	not recorded
Closure reason	not applicable

What this denial means, and to whom

Member Registrar Provider billing Denial analyst Director Payer review

What were we paid, and what can we still pursue?

$455.11 paid, $126.89 withheld

Billed $582.00. The payer paid $455.11, withheld $126.89. Of the $126.89 withheld, $126.89 is modelled as recoverable; less $31.00 to work it, that is $95.89 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 9 Aug 2026, 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.

Work this from the priority queue →

Adjustments

Level	Code	Amount	Counts as
line	PI/26	126.89	withheld