Denial · CARC 26
ELIGIBILITY · NORTHSTAR MUTUAL
Denied
226.00
Withheld
Recoverable
226.00
Realistically collectable
Net of rework
195.00
less 31.00
Appeal window
closed 585d 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 | NORTHSTAR MUTUAL |
| Denial date | 18 Aug 2024 |
| Appeal deadline | 14 Feb 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Which team should investigate first?
Route first to Access Related
The remittance carries CARC 26, and the claim was adjudicated by NORTHSTAR MUTUAL. The application maps CARC 26 to Access Related using the originating-area reference. Review the policy selected for the encounter, the coverage effective dates available at registration, and any eligibility response captured before the service.
From: CARC 26 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
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/26 | 226.00 | withheld |