Denial · CARC 11
CODING · CASCADE CARE
Denied
626.00
Withheld
Recoverable
626.00
Realistically collectable
Net of rework
595.00
less 31.00
Appeal window
closed 331d ago
Closed
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 | CASCADE CARE |
| Denial date | 26 Oct 2024 |
| Appeal deadline | 26 Oct 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Which team should investigate first?
Route first to HIS
The remittance carries CARC 11, and the claim was adjudicated by CASCADE CARE. The application maps CARC 11 to HIS using the originating-area reference. This class of denial is corrected by HIS rather than at registration. Check with that team before assuming a front-desk cause.
From: CARC 11 mapped to an owning department through the originating-area reference.
Limits: This is a routing recommendation, not a root-cause finding. The problem could arise from registration data, a later enrolment change, an interface mismatch, or the payer's own adjudication, and this mapping distinguishes none of them.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/11 | 626.00 | withheld |