CARCContractual Obligation
CARC 101: Predetermination: anticipated payment upon completion of services or claim adjudication
This EOB is a pre-determination of what your insurance would pay — not a final claim decision.
What this means for your claim
A predetermination is a prospective review of coverage before a service is rendered. It's not a guarantee of payment but gives you a cost estimate.
What to do next
- 1
Use this information to estimate your out-of-pocket costs before the service.
- 2
Note that the actual EOB after the service is performed may differ based on how the claim is coded.
- 3
If the actual payment is significantly less than the predetermination, ask the insurer to explain the discrepancy.
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