CARC B15
A prerequisite service is missing
The payer requires another, qualifying service to have been performed and covered before this one can pay.
Why you actually get this
- The qualifying service was performed but billed separately, out of sequence, or by another provider.
- The qualifying service was never delivered.
- The qualifying service was itself denied, so the dependent service cannot pay.
How to check whether it’s correct
- 01Identify what the payer treats as the qualifying service.
- 02Establish whether it was performed, by whom, and whether it paid.
- 03Check the sequence in which the claims reached the payer.
Sometimes worth appealing
Where the qualifying service exists and paid, this is usually a sequencing problem and resolvable. Where the qualifying service was itself denied, fix that one first — this claim will follow.
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.