CARC 22
Another payer may be primary
The payer believes someone else should pay first, and is waiting for coordination of benefits to be resolved.
Why you actually get this
- The patient has more than one active plan and the payers have not agreed which is primary.
- Coordination of benefits information on file with the payer is stale or was never collected.
- A secondary claim was submitted without the primary payer's remittance attached.
How to check whether it’s correct
- 01Ask the patient directly whether they hold other coverage, including through a spouse or a parent.
- 02Confirm the birthday rule or the applicable order-of-benefits rule for dependants.
- 03Check whether the primary remittance was attached to the secondary submission.
Usually worth appealing
This looks uncollectible and frequently is not. Once the order of benefits is established and the primary remittance supplied, the claim usually pays. The risk is a biller classifying it as patient responsibility and billing the patient for something nobody owes yet.
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.