How do I resolve a CO-136 denial?

Pull the original authorization request and approval (if any) Determine whether a retroactive authorization request is an option with this payer See full resolution steps at tryarceum.com.

Can I appeal a CO-136 denial?

Yes. Most CO-136 denials can be appealed within 60-180 days depending on payer. This is appealable if you can demonstrate that the primary payer's coverage rules were actually followed or if the secondary payer misinterpreted the primary payer's adjudication. Use our free tool to generate an appeal letter.

CARC Code

136

🔴 Hard Denial

Prior Payer Coverage Rules Not Followed

The claim was denied because the billing did not follow the rules set by the patient's primary insurance before billing the secondary insurance. This typically happens when coordination of benefits requirements were not met.

cob

Resolution: 35%Hard difficulty21-45 days avg

How to resolve this denial

Which payer denied this claim?

Submit retroactive authorization request with clinical justification; appeal denial

1
Pull the original authorization request and approval (if any)
2
Determine whether a retroactive authorization request is an option with this payer
3
Prepare clinical documentation supporting medical necessity for the service
4
Submit the retroactive authorization request through the payer portal
5
Submit a formal appeal once the authorization is obtained or denied
6
Document all communication with the payer in the patient account

Resolve this denial →

▶✓ 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 CO-136 — stats, related codes, appeal template

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Payer-Specific Notes

How major payers handle CARC 136 by specialty.

Blue Cross Blue Shield

BCBS requires appeal submission within 180 days for most plans.

Appeal Letter Template

Generic appeal template for CARC 136 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 136 indicating: "Failure to follow prior authorization procedures/requirements.." 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.

Generate a personalized appeal letter →

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