Based on the findings of a review organization or the payer's findings.
Group code
CO, PI or PR
Category
Medical Necessity
Risk level
High
Appealable
Yes
See the full resolution workflow for CARC 216
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.
Open in EDI Lab