CARCContractual Obligation
CARC 8: The procedure code is inconsistent with the provider type
The billed service doesn't match the type of provider who performed it according to their license or specialty.
What this means for your claim
Insurers cross-check whether the billed procedure is within the billing provider's scope of practice. A mismatch triggers an adjustment.
What to do next
- 1
Ask your provider if the billing taxonomy code on the claim matches their specialty.
- 2
If a specialist performed work outside their typical billing code set, they may need to refile with documentation of their credentials.
- 3
Contact member services for clarification on which provider type is eligible to bill for this service.
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