What does CARC 109 mean?

CARC 109 means "Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.". The recommended action is: Identify the correct payer and resubmit; check plan enrollment records.

How do I resolve CARC 109?

Verify whether the patient has coverage through another insurance plan Identify the correct payer order (primary, secondary, tertiary) Submit or resubmit the claim to the appropriate payer Include the primary payer's EOB when billing secondary insurance Document coordination of benefits information in the patient account

Can CARC 109 be appealed?

CARC 109 has a 55% recovery rate and typically resolves in 14-30 days. Resolution difficulty is rated Medium.

CARC Code

109

🔴 Hard Denial

Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.

55%

Recovery Rate

14-30 days

Avg. Resolution

Medium

Difficulty

Occasional

Frequency

Recommended Action

Identify the correct payer and resubmit; check plan enrollment records

Step-by-Step Resolution

1
Verify whether the patient has coverage through another insurance plan
2
Identify the correct payer order (primary, secondary, tertiary)
3
Submit or resubmit the claim to the appropriate payer
4
Include the primary payer's EOB when billing secondary insurance
5
Document coordination of benefits information in the patient account

Payer-Specific Notes

How major payers handle CARC 109 in practice.

MetLife Dental

MetLife provides detailed denial reason codes — check EOB for supplemental information.

Common 835 Combinations

CARC 109 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-109

Look up any combination →

Appeal Letter Template

Enter your email to access the full appeal template for CARC 109.

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 109 indicating: "Claim/service not covered by this payer. Send to correct payer/contractor.." 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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