CARC 12
Diagnosis conflicts with the provider type
The payer does not expect a provider of this type to report this diagnosis.
Why you actually get this
- Wrong rendering provider on the claim.
- Taxonomy on file with the payer is out of date.
How to check whether it’s correct
- 01Confirm the rendering provider and their taxonomy with the payer.
- 02Verify the claim was submitted under the right provider.
Usually worth appealing
Generally an enrolment or data problem. Fix it at the payer so it stops recurring.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Claim Adjustment Reason Codes are maintained by X12 as External Code List 139. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.