What does CARC 22 mean?

CARC 22 means "This care may be covered by another payer per coordination of benefits.". The recommended action is: File with primary payer first, then coordinate benefits with secondary.

How do I resolve CARC 22?

Verify patient's primary and secondary insurance coverage at eligibility check Determine which payer is primary based on birthday rule or plan coordination rules Submit claim to the primary payer first and obtain EOB Resubmit to this payer with the primary payer's EOB attached Ensure the primary payer's payment and allowed amount are included in the crossover claim If patient is Medicare primary, verify automatic crossover to Medicaid/Medigap

Can CARC 22 be appealed?

CARC 22 has a 78% recovery rate and typically resolves in 14-30 days. Resolution difficulty is rated Medium.

CARC Code

22

🟡 Soft Denial

This care may be covered by another payer per coordination of benefits.

78%

Recovery Rate

14-30 days

Avg. Resolution

Medium

Difficulty

Common

Frequency

Recommended Action

File with primary payer first, then coordinate benefits with secondary

Step-by-Step Resolution

1
Verify patient's primary and secondary insurance coverage at eligibility check
2
Determine which payer is primary based on birthday rule or plan coordination rules
3
Submit claim to the primary payer first and obtain EOB
4
Resubmit to this payer with the primary payer's EOB attached
5
Ensure the primary payer's payment and allowed amount are included in the crossover claim
6
If patient is Medicare primary, verify automatic crossover to Medicaid/Medigap

Common Remark Codes (RARC)

These RARC codes often appear alongside CARC 22 on remittance advice.

RARC MA04·Secondary payment cannot be considered without the identity of or payment information from the primary payer

→ Attach primary payer EOB to crossover claim

RARC N1·Alert: Refer to provider manual for additional guidance

→ Review COB coordination rules in payer manual

Payer-Specific Notes

How major payers handle CARC 22 in practice.

Delta Dental

Request COB worksheet from patient; Delta uses birthday rule for dependent coverage

MetLife Dental

Dual coverage is common for employed spouses; verify both plans before treatment

Common 835 Combinations

CARC 22 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-22

Look up any combination →

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