What does CARC 120 mean?

CARC 120 means "Patient is covered by a managed care plan.". The recommended action is: Verify network provider status; obtain retroactive authorization or appeal.

How do I resolve CARC 120?

Review the plan's Summary of Benefits to confirm the service is excluded Inform the patient in writing that the service is not covered under their plan Determine if an ABN was issued prior to service (required for Medicare) Bill the patient for the non-covered service if an ABN was signed Document the non-coverage determination in the patient account

Can CARC 120 be appealed?

CARC 120 has a 35% recovery rate and typically resolves in 21-45 days. Resolution difficulty is rated Hard.

CARC Code

120

🔴 Hard Denial

Patient is covered by a managed care plan.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Recommended Action

Verify network provider status; obtain retroactive authorization or appeal

Step-by-Step Resolution

1
Review the plan's Summary of Benefits to confirm the service is excluded
2
Inform the patient in writing that the service is not covered under their plan
3
Determine if an ABN was issued prior to service (required for Medicare)
4
Bill the patient for the non-covered service if an ABN was signed
5
Document the non-coverage determination in the patient account

Payer-Specific Notes

How major payers handle CARC 120 in practice.

MetLife Dental

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

Common 835 Combinations

CARC 120 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-120Appealable

Look up any combination →

Appeal Letter Template

Enter your email to access the full appeal template for CARC 120.

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 120 indicating: "Patient is covered by a Managed Care Plan. All services must be rendered by plan." 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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