Denial · CARC 26
ELIGIBILITY · MERIDIAN HEALTH PLAN
Classification
| Field | Value |
|---|---|
| Primary CARC | 26 |
| All CARCs | 26 |
| Root cause | ELIGIBILITY |
| Owns the fix | Access Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Expenses incurred prior to coverage. Check the enrolment span before appealing. |
| Payer | MERIDIAN HEALTH PLAN |
| Denial date | 16 Feb 2025 |
| Appeal deadline | 17 May 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
The modelled appeal window passed 493 days ago
The 835 reports CARC 26 on 16 Feb 2025, withholding $345.27 from the provider. The matched 834 shows coverage 17 Jan 2024 to open, which includes the service date of 8 Jan 2025. Modelled recoverable $345.27, less an estimated rework cost of $31.00, leaves $314.27 net. The configured appeal window for this payer ends 17 May 2025, 493 days ago. Recommended action: Expenses incurred prior to coverage. Check the enrolment span before appealing. 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.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/26 | 345.27 | withheld |