CARCContractual Obligation
CARC 170: Payment is denied when performed/billed by this type of provider
This service isn't covered when performed by the type of provider who billed it.
What this means for your claim
Some services are only covered if performed by specific provider types (e.g., a test covered only when ordered by an MD, not a chiropractor). Scope-of-practice issues can trigger this.
What to do next
- 1
Ask your insurer which provider type is required for this service to be covered.
- 2
If the service was clinically appropriate and performed by a qualified provider, appeal with credentials documentation.
- 3
For future care, verify coverage requirements by provider type before receiving the service.
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