Expenses incurred prior to coverage.
Group code
CO, PI or PR
Category
Patient Eligibility
Risk level
High
Appealable
No
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 26 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N30 | Patient ineligible for this service. |
| N52 | Patient not enrolled in the billing provider's managed care plan on the date of service. |
| N128 | This amount represents the prior to coverage portion of the allowance. |
| N216 | We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package. |
| N622 | Not covered based on the date of injury/accident. |
| N650 | This policy was not in effect for this date of loss. No coverage is available. |
| N652 | The date of service is before the date of loss. |
See the full resolution workflow for CARC 26
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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