How long does it take to fix a denied insurance claim?

Correcting a denied insurance claim typically takes 30 to 60 days, depending on the complexity of the error and the insurer's internal appeal processing time.

Why was my insurance claim denied?

Claims are typically denied due to administrative errors, eligibility issues, or lack of prior authorization. Decoding the CARC and RARC codes on your EOB is the first step to knowing the exact reason.

Claim Denial Codes Explained | CARC & RARC Code Lookup

What Are Claim Denial Codes?

Claim denial codes are used by insurance companies to explain why a medical claim was denied or not fully paid. Understanding claim denial codes is essential for resolving billing issues and reducing out-of-pocket costs.

These codes help identify issues such as:

Missing or incomplete patient information

Incorrect billing or CPT codes (Coding Errors)

Coverage limitations or out-of-network services

Policy restrictions and medical necessity denials

The two main types you will see on your EOB (Explanation of Benefits) are CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes).

Common Claim Denial Codes List & Meanings

Below are some of the most frequently searched CARC and RARC codes that patients encounter on their Explanation of Benefits (EOB).

CO-45 – Charges exceed fee schedule (Contractual obligation)

This is a very common code. It means your provider charged more than the "allowable amount" agreed upon in their contract with your insurance company. This amount is usually written off by the provider and you should not be billed for the difference.

CO-16 – Missing or incorrect information

Your claim was denied because it was submitted with incomplete or incorrect details. This could be a missing birth date, an incorrect NPI number, or a missing procedure code. Contact your provider’s billing office to correct and resubmit.

CO-97 – Service included in another procedure (Bundling)

This denial happens when insurance believes the service listed is already part of a major procedure billed on the same day. This is often an "unbundling" error by the hospital. You can verify bundling rules using our CPT code lookup tool.

PR-1 – Deductible amount remains

This code indicates that the insurance company has applied the charge toward your annual deductible. This is your "Patient Responsibility," meaning you are responsible for paying this portion of the bill.

How to Read a Claim Denial Code

A claim denial code typically includes a primary reason (CARC) and an additional detailed explanation (RARC). Understanding both is key to a successful appeal.

Understanding both helps you:

Identify the exact issue that caused the payment reduction

Know whether it’s a billing error or an insurance coverage problem

Take the correct next step with your healthcare provider

What to Do If Your Claim Is Denied

Denials aren't final. If your insurance claim is denied, follow these 5 steps:

Review the denial code: Use our tool to understand the specific reason for denial.

Verify CPT codes: Cross-check your bill using our CPT code lookup tool.

Check coverage: Contact your insurer to clarify policy limitations.

Contact provider: Often, denials arise from simple billing office clerical errors.

File an Appeal: If the denial is unjustified, submit a formal dispute or appeal.

Pro Tip: Understanding the denial code is the first step to resolving the issue and getting your medical costs covered.

Claim Denial Codes List (CARC & RARC) + Meanings & Fixes

What Are Claim Denial Codes?

Search CARC & RARC Codes