CARCContractual Obligation
CARC 176: Services not related to the specific accident/illness
The service doesn't appear to be connected to the injury or illness for which you're being treated under a specific claim or benefit.
What this means for your claim
For claims linked to a specific event (e.g., auto accident, specific injury), the insurer may exclude services it deems unrelated to that event.
What to do next
- 1
Ask your provider to document the clinical link between the service and the relevant condition.
- 2
File an appeal with chart notes that clearly connect the service to the covered diagnosis.
- 3
If auto insurance or workers' comp is involved, verify which carrier should be primary.
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