CARC Code

26

🔴 Hard Denial

Expenses Before Coverage Started

The service was provided before the patient's insurance coverage began or became effective. Insurance plans only cover expenses incurred on or after the coverage effective date.

eligibility
Resolution: 35%Hard difficulty30-60 days avg

How to resolve this denial

Verify effective date and bill patient if services pre-date coverage

  1. 1

    Verify the patient's coverage effective date with the payer

  2. 2

    Compare date of service against the coverage effective date

  3. 3

    If coverage was retroactive, request retroactive adjustment from payer with enrollment documentation

  4. 4

    If truly pre-coverage, bill the patient directly after obtaining signed financial responsibility form

  5. 5

    Document in patient account that services were rendered before coverage

  6. 6

    For Medicare/Medicaid retroactive eligibility, check eligibility for retroactive months

Resolve this denial →
▶✓ Pre-action checklist — verify before contacting the payer

  1. Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.

  2. Verify the claim was submitted with correct patient eligibility and benefit information.

  3. Check if this denial applies to a specific line item or the entire claim.

▶More about CO-26 — stats, related codes, appeal template

35%

Recovery Rate

30-60 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Payer-Specific Notes

How major payers handle CARC 26 by specialty.

Medicaid

Medicaid retroactive eligibility can extend 3 months back; check retro eligibility before billing patient

Medicare

Part B effective date is first of month of enrollment; verify Part B enrollment date

Common 835 Combinations

CARC 26 most often appears with these Group Code + RARC combinations on 835 remittances.

PRPR-26

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 26 denials.

We are appealing the denial of claim [CLAIM_NUMBER] under CARC 26 citing pre-coverage expenses. Our records indicate the patient's coverage effective date was [EFFECTIVE_DATE], and services were rendered on [DOS] which we believe falls within the coverage period. Enclosed is the patient's enrollment documentation.

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