CARC 245: Provider performance program withhold.
Provider performance program withhold.
CARC 245 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 245 means
The official X12 description is: “Provider performance program withhold.”
In plain language: Provider performance program withhold.
What to do next 245
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 245 group codes explained
On the 835 ERA, CARC 245 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 245 mean?
Provider performance program withhold. In plain language: Provider performance program withhold.
Is CARC 245 appealable?
CARC 245 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 245 appear under?
CARC 245 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 245 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.
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Sources
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