Denial · CARC 27
ELIGIBILITY · CASCADE CARE
Denied
271.97
Withheld
Recoverable
271.97
Realistically collectable
Net of rework
240.97
less 31.00
Appeal window
closed 91d ago
Closed
Classification
| Field | Value |
|---|---|
| Primary CARC | 27 |
| All CARCs | 27 |
| Root cause | ELIGIBILITY |
| Owns the fix | Access Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Expenses incurred after coverage terminated. Check the enrolment span: if the member was covered on the service date this is wrongly denied and worth appealing. |
| Payer | CASCADE CARE |
| Denial date | 23 Jun 2025 |
| Appeal deadline | 23 Jun 2026 |
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?
Coverage record conflicts with the stated reason
The payer asserts a coverage problem under CARC 27. The matched 834 shows coverage from 5 Jun 2024 to open, which includes the service date of 3 Apr 2025. The payer would need to re-check the eligibility source it adjudicated against.
From: 835 CARC against the matched 834 enrolment span.
Limits: A coverage span is not a final benefit determination. A retroactive termination, a plan rule or a different eligibility feed on the payer's side could each explain the difference, and none of them is visible here.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/27 | 271.97 | withheld |