What does CARC 185 mean?

CARC 185 means "The rendering provider is not eligible to perform the service billed.". The recommended action is: Verify rendering provider credentials and enrollment; re-render or appeal with credentials.

How do I resolve CARC 185?

Verify the rendering or referring provider's enrollment status with this payer Check that the provider's NPI, taxonomy, and license are current and active If the provider is not enrolled, initiate enrollment before resubmitting Obtain a re-referral or re-order from an enrolled, eligible provider if needed Resubmit the claim with the correct enrolled provider information

Can CARC 185 be appealed?

CARC 185 has a 35% recovery rate and typically resolves in 21-45 days. Resolution difficulty is rated Hard.

CARC Code

185

🔴 Hard Denial

The rendering provider is not eligible to perform the service billed.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Recommended Action

Verify rendering provider credentials and enrollment; re-render or appeal with credentials

Step-by-Step Resolution

1
Verify the rendering or referring provider's enrollment status with this payer
2
Check that the provider's NPI, taxonomy, and license are current and active
3
If the provider is not enrolled, initiate enrollment before resubmitting
4
Obtain a re-referral or re-order from an enrolled, eligible provider if needed
5
Resubmit the claim with the correct enrolled provider information

Payer-Specific Notes

How major payers handle CARC 185 in practice.

MetLife Dental

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

Appeal Letter Template

Enter your email to access the full appeal template for CARC 185.

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 185 indicating: "The rendering provider is not eligible to perform the service billed.." 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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