CARC 3: Co-payment Amount
Your fixed-dollar copay for the visit. Patient responsibility — not a denial.
CARC 3 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 3 means
The official X12 description is: “Co-payment Amount”
In plain language: Your fixed-dollar copay for the visit. Patient responsibility — not a denial.
Common scenarios
- Office visit
- Specialist visit
- Urgent care
What to do next 3
Pay the copay. Check whether preventive services (annual physical, vaccines) should have been copay-exempt under ACA §2713.
CARC 3 group codes explained
On the 835 ERA, CARC 3 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 3 mean?
Co-payment Amount In plain language: Your fixed-dollar copay for the visit. Patient responsibility — not a denial.
Is CARC 3 appealable?
CARC 3 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Pay the copay. Check whether preventive services (annual physical, vaccines) should have been copay-exempt under ACA §2713.
Which group code does CARC 3 appear under?
CARC 3 most often appears under: PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
When does CARC 3 typically appear on a denial?
Common scenarios: Office visit; Specialist visit; Urgent care.
What should I do if I see CARC 3 on the 835?
Pay the copay. Check whether preventive services (annual physical, vaccines) should have been copay-exempt under ACA §2713.
Related resources
Sources
Contact: hello@denialhelp.com