X12 Ingest & Denial Analytics

Demo Environment — Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Denials›TIMELY_FILING›claim B07M000883

Denial · CARC 29

TIMELY_FILING · MERIDIAN HEALTH PLAN

Denied
397.00
Withheld
Recoverable
0.00
Realistically collectable
Net of rework
0.00
less 31.00
Appeal window
closed 682d ago
Closed

Classification

FieldValue
Primary CARC29
All CARCs29
Root causeTIMELY_FILING
Owns the fixBilling Related
Appealableyes
Recoverableno
Recommended actionFiling limit expired. Rarely recoverable; fix the charge lag upstream.
PayerMERIDIAN HEALTH PLAN
Denial date11 Aug 2024
Appeal deadline9 Nov 2024

Denial workflow

FieldValue
Current statusnew
Appeal outcomenot recorded
Closure reasonnot applicable

What this denial means, and to whom

Which team should investigate first?

Route first to Billing Related

The remittance carries CARC 29, and the claim was adjudicated by MERIDIAN HEALTH PLAN. The application maps CARC 29 to Billing Related using the originating-area reference. This class of denial is corrected by Billing Related rather than at registration. Check with that team before assuming a front-desk cause.

From: CARC 29 mapped to an owning department through the originating-area reference.

Limits: This is a routing recommendation, not a root-cause finding. The problem could arise from registration data, a later enrolment change, an interface mismatch, or the payer's own adjudication, and this mapping distinguishes none of them.

Adjustments

LevelCodeAmountCounts as
linePI/29397.00withheld