Instantly find explanations, causes, and resolution steps for every Claim Adjustment Reason Code (CARC) and Remark Code.
Claim Adjustment Reason Codes (CARC) explain why a payment differs from what was billed. Every 835 ERA and EOB uses these standardized codes.
Search any code or keyword above. Each page includes the full description, common causes, resolution steps, and appeal guidance.
Each denial code page also links to a dedicated Remark Code page — optimized for providers searching for ERA remark code context.
Most denials are reversible. Our guides walk you through the correct steps to correct, resubmit, or formally appeal each denial type.
| Code | Description | View |
|---|---|---|
| 7 | No benefit The patient does not have benefits for this service under this Plan. | Details → |
| 8 | The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage… | Details → |
| 8 | Denied. Chemonucleolysis is allowed once in a lifetime only. | Details → |
| 8 | Not covered The service provided is not a covered benefit under this plan. | Details → |
| 9 | The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthc… | Details → |
| 9 | Maximum 2 service units allowed. | Details → |
| 9 | Before eff date The date you received medical services on the above claim was prior t… | Details → |
| 10 | The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Heal… | Details → |
| 10 | Maximum 40 hours payable per vocational referral. | Details → |
| 10 | Prior auth required Utilization Management has denied prior authorization for this se… | Details → |
| 11 | The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare … | Details → |
| 11 | Maximum 50 hours payable per vocational referral. | Details → |
| 11 | Not a benefit Not a benefit | Details → |
| 12 | The diagnosis is inconsistent with the provider type. Usage: Refer to the 835 Healthc… | Details → |
| 12 | Maximum 2 hours allowed per vocational referral. | Details → |
| 12 | Exceeds annual amount This claim exceeds the annual amount allowed for this benefit. | Details → |
| 13 | The date of death precedes the date of service. Start: 01/01/1995 | Details → |
| 13 | Quality or level of service does not meet L&I standards. | Details → |
| 13 | The date of death precedes the date of service. | Details → |
| 13 | Lifetime max This claim exceeds the lifetime maximum allowed for this benefit. | Details → |
| 14 | The date of birth follows the date of service. Start: 01/01/1995 | Details → |
| 14 | Maximum 1 service unit allowed for same day/diagnosis. | Details → |
| 14 | Visit limit This claim exceeds the visit limit allowed for this benefit. | Details → |
| 15 | The authorization number is missing, invalid, or does not apply to the billed service… | Details → |
| 15 | Maximum of 2 hours travel wait time allowed. | Details → |
| 15 | Dollar limit This claim exceeds the dollar limit allowed for this benefit. | Details → |
| 16 | Claim/service lacks information or has submission/billing error(s). Usage: Do not use… | Details → |
| 16 | Thank you. Your effort to complete this bill correctly has been appreciated. | Details → |
| 16 | Claim/service lacks information or has submission/billing error(s) Missing/incomplet… | Details → |
| 16 | Exceeds auth This services exceeds the number of services authorized. | Details → |
| 17 | Requested information was not provided or was insufficient/incomplete. At least one R… | Details → |
| 17 | Denied. Meal receipts must include business name or be accompanied by cash registered… | Details → |
| 17 | Auth for different provider The authorization on file was issued to a different provi… | Details → |
| 18 | Exact duplicate claim/service (Use only with Group Code OA except where state workers… | Details → |
| 18 | Additional views/units are not payable on MRI's. | Details → |
| 18 | Duplicate claim has already been submitted and processed | Details → |
| 18 | Experimental Procedure has been determined as being experimental in nature. | Details → |
| 19 | This is a work-related injury/illness and thus the liability of the Worker's Compensa… | Details → |
| 19 | Amount paid is according to hours lost from work per the daily compensation rate. | Details → |
| 19 | Mental Health This claim is the responsibility of Bravo Health's Delegated Mental Hea… | Details → |
| 20 | This injury/illness is covered by the liability carrier. Start: 01/01/1995 | Last Mo… | Details → |
| 20 | This service is payable only once and must be billed as 1 line item and 1 unit of ser… | Details → |
| 20 | Not covered This service is not a covered benefit for this plan | Details → |
| 21 | This injury/illness is the liability of the no-fault carrier. Start: 01/01/1995 | La… | Details → |
| 21 | Denied. Free parking available at this facility. | Details → |
| 21 | Capitated This is a capitated service. | Details → |
| 22 | This care may be covered by another payer per coordination of benefits. Start: 01/01… | Details → |
| 22 | Consultations not payable to attending physician. | Details → |
| 22 | This claim appears to be covered by a primary payer. The primary payerinformation was… | Details → |
| 22 | Hospice Hospice Member - Submit to Original Medicare | Details → |
| 23 | The impact of prior payer(s) adjudication including payments and/or adjustments. (Use… | Details → |
| 23 | Denied. Submit bill to party who requested testimony (e.g. attorney general office, B… | Details → |
| 23 | Capitated This is a capitated service. | Details → |
| 24 | Charges are covered under a capitation agreement/managed care plan. Start: 01/01/199… | Details → |
| 24 | Maximum of 1 hour allowable only. | Details → |
| 24 | CompCare Submit all Inpatient Mental Health to Comp Care | Details → |
| 25 | Payment denied. Your Stop loss deductible has not been met. Start: 01/01/1995 | Stop… | Details → |
| 25 | Accumulated services have exceeded L&I limit. | Details → |
| 26 | Expenses incurred prior to coverage. Start: 01/01/1995 | Details → |
| 26 | This is an individual interim payment. | Details → |
Medical claim denial codes — formally known as Claim Adjustment Reason Codes (CARC) — are standardized identifiers maintained by the X12 standards body and used across all Medicare, Medicaid, and commercial payer 835 electronic remittance transactions. When a claim is paid at a different amount than billed, at least one CARC code must accompany the remittance advice to indicate the specific reason for the adjustment.
The most frequently encountered codes include CO-16 (missing or invalid claim information), CO-45 (charges exceeding fee schedule), PR-1 (patient deductible), CO-29 (timely filing deadline exceeded), and CO-4 (procedure code inconsistent with modifier). Each represents a distinct, actionable reason that has a defined resolution pathway.