CARC 248: Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
CARC 248 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 248 means
The official X12 description is: “Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.”
In plain language: Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
What to do next 248
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 248 group codes explained
On the 835 ERA, CARC 248 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 248 mean?
Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim. In plain language: Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
Is CARC 248 appealable?
CARC 248 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 248 appear under?
CARC 248 most often appears under: PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
What should I do if I see CARC 248 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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