Denial · CARC 27
ELIGIBILITY · NORTHSTAR MUTUAL
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 | NORTHSTAR MUTUAL |
| Denial date | 26 Apr 2026 |
| Appeal deadline | 23 Oct 2026 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
$53.76 paid, $22.24 withheld
Billed $76.00. The payer paid $53.76, withheld $22.24. Of the $22.24 withheld, $22.24 is modelled as recoverable; less $31.00 to work it, that is -$8.76 net. 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. On these estimates the work costs more than it returns, which is a judgement about this model's figures rather than a rule.
From: 835 CLP amounts and CAS adjustments on this claim; the denial derivation for the modelled recoverable amount and filing window.
Limits: Patient responsibility reported on an 835 is not revenue. This application cannot say whether the practice billed it, whether the patient paid, or whether a secondary payer covered it — those live in a billing system it does not read. The recoverable figure and the deadline are estimates, not a payer commitment.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/27 | 22.24 | withheld |