Denial · CARC 50
MEDICAL_NECESSITY · MERIDIAN HEALTH PLAN
Denied
0.00
Withheld
Recoverable
0.00
Realistically collectable
Net of rework
0.00
less 31.00
Appeal window
closed 430d ago
Closed
Classification
| Field | Value |
|---|---|
| Primary CARC | 50 |
| All CARCs | 50,45 |
| Root cause | MEDICAL_NECESSITY |
| Owns the fix | Utilization |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Not deemed medically necessary. Appeal with clinical documentation. |
| Payer | MERIDIAN HEALTH PLAN |
| Denial date | 20 Apr 2025 |
| Appeal deadline | 19 Jul 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Is the available evidence consistent with the stated reason?
No independent evidence for this reason
CARC 50 is not one this data can test. The cross-checks cover coverage assertions, against the 834, and authorisation assertions, against the 278. For every other reason the payer's statement stands unexamined here.
From: The CARC on this remittance, and the cross-checks available.
Limits: Absence of contradicting evidence is not agreement. This says only that the application holds no record able to test the assertion — not that the denial is correct.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PR/50 | 520.65 | write-off |
| line | CO/45 | 280.35 | write-off |