CARC 253: Sequencing of therapy and/or diagnostic treatment is incorrect
Your insurer says the order in which treatments were tried doesn't follow their required clinical pathway.
What this means for your claim
Step therapy protocols require that less expensive or less intensive treatments be tried first before advancing to higher-cost options. If the sequence wasn't followed, the advanced treatment may be denied.
What to do next
- 1
Ask your insurer what their step therapy requirements were for this diagnosis.
- 2
If step therapy was followed, submit documentation of prior treatments with dates and outcomes.
- 3
If step therapy was skipped for a valid clinical reason (e.g., prior treatment failure, contraindication), ask your physician to document the exception and file an appeal.
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