CARCContractual Obligation
CARC 12: The diagnosis is inconsistent with the admission type
The diagnosis doesn't match how the admission was categorized (e.g., elective vs. emergency).
What this means for your claim
Inpatient admissions are categorized by type (emergency, urgent, elective, newborn). If the diagnosis suggests emergency but the claim was filed as elective, costs may be adjusted.
What to do next
- 1
Ask the hospital billing department to confirm the admission type code on the claim.
- 2
If you were admitted through the ER or for an urgent condition, the admission type should reflect that.
- 3
Request a corrected claim if the admission type was miscoded.
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