Denial · CARC 11
CODING · NORTHSTAR MUTUAL
Denied
6.85
Withheld
Recoverable
6.85
Realistically collectable
Net of rework
-24.15
costs 31.00 to work — more than it returns
Appeal window
closed 501d ago
Closed
Classification
| Field | Value |
|---|---|
| Primary CARC | 11 |
| All CARCs | 11 |
| Root cause | CODING |
| Owns the fix | HIS |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Diagnosis inconsistent with procedure; review coding and resubmit. |
| Payer | NORTHSTAR MUTUAL |
| Denial date | 10 Nov 2024 |
| Appeal deadline | 9 May 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Does this mean I owe money?
The care was for PRIYA NGUYEN, a dependent on this policy
The payer withheld $6.85 from the provider for this service. The 835 did not assign any of this adjustment to the patient, so nothing here was reported as the member's responsibility. Do not treat the denied amount as a patient bill on the strength of this remittance alone. If a bill arrives for it, ask the provider what correction or appeal is under way, and question any balance the remittance does not support.
From: 835 CAS adjustment group codes on this remittance; the 837P patient loop that identifies who was treated.
Limits: This says what the 835 reported, not what was billed. A later remittance, a secondary payer or a correction can each change what the member is asked to pay, and none of that is visible here.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/11 | 6.85 | withheld |