CARC 2
Applied to coinsurance
Not a denial. The patient's share of the allowed amount under their plan's coinsurance.
Why you actually get this
- Standard cost sharing after the deductible is met.
- A plan with coinsurance applying from the first dollar, with no deductible phase.
How to check whether it’s correct
- 01Confirm the coinsurance percentage matches the plan.
- 02Verify it was calculated on the allowed amount rather than the billed charge.
Rarely worth appealing
Correct processing in almost all cases. Check only where the percentage or the base amount looks wrong.
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.