Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. To be used for Property and Casualty only.
Group code
CO, PI or PR
Category
P&C Guidelines
Risk level
Medium
Appealable
Review Required
See the full resolution workflow for CARC P5
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