Denial · CARC 11 — DenialIntel

Denials›CODING›claim B07M000761

Denial · CARC 11

CODING · NORTHSTAR MUTUAL

Denied

127.00

Withheld

Recoverable

127.00

Realistically collectable

Net of rework

96.00

less 31.00

Appeal window

171

Days left

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	13 Sep 2026
Appeal deadline	12 Mar 2027

Denial workflow

Field	Value
Current status	new
Appeal outcome	not recorded
Closure reason	not applicable

What this denial means, and to whom

Member Registrar Provider billing Denial analyst Director Payer review

What should I investigate, and how urgent is it?

Appealable · $96.00 modelled net of rework

The 835 reports CARC 11 on 13 Sep 2026, withholding $127.00 from the provider. Modelled recoverable $127.00, less an estimated rework cost of $31.00, leaves $96.00 net. The configured appeal window for this payer ends 12 Mar 2027, in 171 days. Recommended action: Diagnosis inconsistent with procedure; review coding and resubmit. Confirm the contractual deadline and any exception, reconsideration or correction route with the payer before closing the case.

From: Denial derivation: root cause, appealability, the recoverable amount net of an estimated rework cost, and a filing deadline derived from the denial date.

Limits: The deadline and the recoverable amount are application estimates. The deadline is the denial date plus a configured per-payer window, not a term read from the payer's contract or an appeal notice, and the recoverable figure is a model rather than a promise of payment. Confirm both against the policy before relying on them.

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Adjustments

Level	Code	Amount	Counts as
line	PI/11	127.00	withheld