CARC 22: This care may be covered by another payer per coordination of benefits.
The carrier thinks another insurance plan should pay first (or jointly) and won't process until that's resolved.
CARC 22 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 22 means
The official X12 description is: “This care may be covered by another payer per coordination of benefits.”
In plain language: The carrier thinks another insurance plan should pay first (or jointly) and won't process until that's resolved.
Common scenarios
- Dual coverage (employer + spouse's employer)
- Medicare + supplemental
- Auto / workers' comp possibly responsible
- Birthday rule disagreement for child
What to do next 22
Confirm your coordination of benefits with both carriers. If only one plan exists, file a COB update with the carrier. If two plans, get the primary to process first then resubmit to secondary.
DenialHelp drafts the appeal letter for you in about five minutes. We cite the federal appeal-rights regulation that applies to your plan type (ACA §2719, ERISA §503, NSA §2799A, 42 CFR 422 Subpart M, or 42 CFR 438 Subpart F), the insurer's own coverage policy, and the relevant clinical guideline.
CARC 22 group codes explained
On the 835 ERA, CARC 22 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 22 mean?
This care may be covered by another payer per coordination of benefits. In plain language: The carrier thinks another insurance plan should pay first (or jointly) and won't process until that's resolved.
Is CARC 22 appealable?
Yes — CARC 22 is one of the codes that commonly supports an appeal. Confirm your coordination of benefits with both carriers. If only one plan exists, file a COB update with the carrier. If two plans, get the primary to process first then resubmit to secondary.
Which group code does CARC 22 appear under?
CARC 22 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
When does CARC 22 typically appear on a denial?
Common scenarios: Dual coverage (employer + spouse's employer); Medicare + supplemental; Auto / workers' comp possibly responsible; Birthday rule disagreement for child.
How do I appeal a CARC 22 denial?
Confirm your coordination of benefits with both carriers. If only one plan exists, file a COB update with the carrier. If two plans, get the primary to process first then resubmit to secondary.
Related resources
Sources
Appeal a CARC 22 denial
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