CARC Code
100
Payment Made to Patient
The insurance company sent the payment directly to the patient or responsible party instead of to the provider. This means the provider has not yet been paid by the insurer for this service.
patient responsibilityHow to resolve this denial
Verify payment was made to patient; collect from patient if needed
- 1
Verify patient's cost-share obligation on the Explanation of Benefits
- 2
Cross-reference with the patient's Summary of Benefits and Coverage
- 3
Calculate the correct patient responsibility amount
- 4
Issue a patient statement within 30 days of claim adjudication
- 5
Document the patient balance in the account notes
▶✓ Pre-action checklist — verify before contacting the payer
Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.
▶More about PR-100 — stats, related codes, appeal template
99%
Recovery Rate
1-3 days
Avg. Resolution
Easy
Difficulty
Rare
Frequency
Payer-Specific Notes
How major payers handle CARC 100 by specialty.
UnitedHealthcare
Review UHC's online claim status tool for additional detail on this adjustment.
Appeal Letter Template
Generic appeal template for CARC 100 denials.
We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 100 indicating: "Payment made to patient/insured/responsible party/employer.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.
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