CARC 32
Not an eligible dependant
The payer does not recognise the patient as a dependant eligible under the subscriber's plan.
Why you actually get this
- A dependant has aged out of the plan.
- A newly added dependant has not yet been processed by the payer.
- The dependant is enrolled under a different subscriber than the claim states.
How to check whether it’s correct
- 01Confirm the dependant's age against the plan's limit on the date of service.
- 02Ask whether an enrolment change is pending.
- 03Verify the subscriber on the claim is the one the dependant is enrolled under.
Sometimes worth appealing
Worth pursuing where an enrolment is pending or the wrong subscriber was used. Where a dependant has genuinely aged out, the answer is to find their current coverage.
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.