CARC 104: Managed care withholding.
Managed care withholding.
CARC 104 is the code your insurance company used to explain why your claim was reduced, denied, or paid less than expected. It appears on your Explanation of Benefits (EOB) — the statement your plan sends after a claim is processed. Here's what it means for you and what you can do about it.
What CARC 104 means
The official X12 description is: “Managed care withholding.”
In plain language: Managed care withholding.
What to do next 104
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 104 group codes explained
On the 835 ERA, CARC 104 appears alongside a group code that signals who is financially responsible for the adjustment. OA (Other Adjustment) — Informational or coordination-related adjustment. Usually means another payer is involved or there's a non-claim-related accounting entry.
Frequently asked questions
What does CARC 104 mean?
Managed care withholding. In plain language: Managed care withholding.
Is CARC 104 appealable?
CARC 104 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Which group code does CARC 104 appear under?
CARC 104 most often appears under: OA (Other Adjustment) — Informational or coordination-related adjustment. Usually means another payer is involved or there's a non-claim-related accounting entry.
What should I do if I see CARC 104 on the 835?
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Related resources
Sources
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