Non-compliance with the physician self referral prohibition legislation or payer policy.
Group code
CO, PI or PR
Category
Billing
Risk level
High
Appealable
Review Required
See the full resolution workflow for CARC 213
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 requirements.
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