CARC Code
215
Third Party Settlement Subrogation
The claim was adjusted because another party (like an auto insurance company or workers' compensation carrier) has already paid or settled this injury/accident, and the health insurer has the right to recover costs from that settlement.
contractualHow to resolve this denial
Accept subrogation adjustment — applies when third-party settlement has been reached
- 1
Review the remittance advice to confirm the adjustment amount is accurate
- 2
Verify the contractual write-off against your fee schedule
- 3
Post the adjustment to the patient account
- 4
Do not balance bill the patient for this contractual reduction
- 5
Document the adjustment in your billing system
▶✓ 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-215 — 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 215 by specialty.
UnitedHealthcare
Review UHC's online claim status tool for additional detail on this adjustment.
Appeal Letter Template
Generic appeal template for CARC 215 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 215 indicating: "Based on subrogation of a third party settlement.." 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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