CARC 27
Coverage had already ended
The patient's coverage with this payer terminated before the date of service.
Why you actually get this
- Coverage lapsed between the appointment being booked and the patient arriving.
- Employment ended and the plan terminated with it.
- Eligibility was verified at registration months earlier and never rechecked.
How to check whether it’s correct
- 01Confirm the termination date against the date of service.
- 02Establish whether replacement coverage existed on that date.
- 03Review when eligibility was last verified for this patient.
Rarely worth appealing
If coverage genuinely ended, there is nothing to appeal — the work is finding the correct payer or converting to patient responsibility. The useful response is upstream: verify eligibility at booking and again on the day. This denial is almost entirely preventable.
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.