CARCContractual Obligation
CARC 47: This (these) diagnosis(es) is (are) not covered, missing, or are invalid
The diagnosis code on the claim is missing, invalid, or not covered by your plan.
What this means for your claim
Every claim needs at least one valid ICD-10 diagnosis code. A missing, outdated, or clearly incorrect code will cause a denial.
What to do next
- 1
Ask your provider to verify the ICD-10 code used and whether it was submitted correctly.
- 2
If the diagnosis code was outdated (ICD-9 codes are no longer accepted), ask for a resubmission with the correct ICD-10.
- 3
If the diagnosis itself isn't covered under your plan, ask your provider to appeal with clinical notes showing medical necessity.
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