CARC 2: Coinsurance Amount
Your share of the cost as a percentage (e.g. 20%) after the deductible. Patient responsibility — not a denial.
CARC 2 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 2 means
The official X12 description is: “Coinsurance Amount”
In plain language: Your share of the cost as a percentage (e.g. 20%) after the deductible. Patient responsibility — not a denial.
Common scenarios
- After deductible met
- In-network covered service
- Specialist visit at higher coinsurance tier
What to do next 2
Pay the amount. If your out-of-pocket maximum was already met, request a corrected EOB — the carrier should have stopped charging coinsurance.
CARC 2 group codes explained
On the 835 ERA, CARC 2 appears alongside a group code that signals who is financially responsible for the adjustment. PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
Frequently asked questions
What does CARC 2 mean?
Coinsurance Amount In plain language: Your share of the cost as a percentage (e.g. 20%) after the deductible. Patient responsibility — not a denial.
Is CARC 2 appealable?
CARC 2 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Pay the amount. If your out-of-pocket maximum was already met, request a corrected EOB — the carrier should have stopped charging coinsurance.
Which group code does CARC 2 appear under?
CARC 2 most often appears under: PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
When does CARC 2 typically appear on a denial?
Common scenarios: After deductible met; In-network covered service; Specialist visit at higher coinsurance tier.
What should I do if I see CARC 2 on the 835?
Pay the amount. If your out-of-pocket maximum was already met, request a corrected EOB — the carrier should have stopped charging coinsurance.
Related resources
Sources
Contact: hello@denialhelp.com