CARC 21
Belongs to a no-fault carrier
The payer treats the injury as the responsibility of a no-fault auto insurer.
Why you actually get this
- The injury arose from a motor vehicle incident in a no-fault jurisdiction.
- No-fault coverage exists and was not billed first.
How to check whether it’s correct
- 01Establish whether no-fault coverage applies and what its limits are.
- 02Confirm whether those limits have been exhausted, which may return liability to the health plan.
Sometimes worth appealing
Where no-fault limits are exhausted, the health plan generally becomes responsible and the claim can go back with evidence. Keep the exhaustion documentation — it is what makes the resubmission work.
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.