CARC 252
Documentation required before it can be adjudicated
The payer is asking for records before it will make a decision. Not yet a refusal.
Why you actually get this
- The payer requires the clinical record for this service type.
- A request for records was sent and not actioned in time.
- The service triggers a documentation review by policy.
How to check whether it’s correct
- 01Identify exactly which record the payer wants — the remark code usually says.
- 02Check whether a request was already received and missed.
- 03Confirm the submission deadline for the documentation.
Usually worth appealing
This is a request, not a denial. Supplying the record normally resolves it. The money is lost only when the request goes unanswered until the window closes — which is why these should be worked ahead of older, harder denials.
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.