Denial · CARC 16
BILLING_ERROR · NORTHSTAR MUTUAL
Classification
| Field | Value |
|---|---|
| Primary CARC | 16 |
| All CARCs | 16 |
| Root cause | BILLING_ERROR |
| Owns the fix | Billing Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Claim lacks information. Read the accompanying RARC for what is missing. |
| Payer | NORTHSTAR MUTUAL |
| Denial date | 21 Jun 2026 |
| Appeal deadline | 18 Dec 2026 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
$493.40 paid, $399.60 withheld
Billed $893.00. The payer paid $493.40, withheld $399.60. Of the $399.60 withheld, $399.60 is modelled as recoverable; less $31.00 to work it, that is $368.60 net. Claim lacks information. Read the accompanying RARC for what is missing. To pursue the withheld amount, quote the payer's own claim number from the remittance and the adjudication date 21 Jun 2026, and confirm the route and deadline with the payer.
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/16 | 399.60 | withheld |