Failure to follow prior payer's coverage rules. (Use only with Group Code OA)
Group code
OA
Category
Coordination of Benefits
Risk level
High
Appealable
Yes
See the full resolution workflow for CARC 136
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every CARC and RARC pairing, plus payer-specific quirks.
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