CARC 215: Based on subrogation of a third-party settlement.
Based on subrogation of a third-party settlement.
CARC 215 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 215 means
The official X12 description is: “Based on subrogation of a third-party settlement.”
In plain language: Based on subrogation of a third-party settlement.
What to do next 215
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 215 group codes explained
On the 835 ERA, CARC 215 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 215 mean?
Based on subrogation of a third-party settlement. In plain language: Based on subrogation of a third-party settlement.
Is CARC 215 appealable?
CARC 215 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 215 appear under?
CARC 215 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 215 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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