CARC Code
296
Authorization Not Valid for Provider
The authorization or precertification number exists and may be legitimate, but it was issued for a different provider and cannot be used for claims submitted by your practice.
authorizationHow to resolve this denial
Review and resolve CARC 296: Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed provider.
- 1
Review the full denial on the 835 ERA for CARC 296: "Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed provider."
- 2
Pull the original claim and all supporting documentation for the date of service.
- 3
Identify the specific data element, policy requirement, or documentation gap that triggered this adjustment.
- 4
Correct the identified issue — update claim data, gather missing documentation, or verify coverage details.
- 5
Resubmit as a corrected claim (frequency type 7) or file a written appeal with supporting documentation.
- 6
Follow up with the payer within 10-15 business days to confirm adjudication.
▶✓ 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-296 — stats, related codes, appeal template
60%
Recovery Rate
7-21 days
Avg. Resolution
Medium
Difficulty
Rare
Frequency
Payer-Specific Notes
How major payers handle CARC 296 by specialty.
General
Confirm payer-specific policy for CARC 296 and submit corrected claim or appeal as appropriate.
Appeal Letter Template
Generic appeal template for CARC 296 denials.
Dear [Payer Name] Appeals Department, We are writing to appeal the denial of claim [CLAIM #] for patient [PATIENT NAME] (Member ID: [ID]) for services rendered on [DATE OF SERVICE]. The claim was denied with CARC 296: "Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed provider." We believe this denial is in error for the following reasons: [INSERT CLINICAL/ADMINISTRATIVE JUSTIFICATION] We respectfully request reconsideration and payment of this claim. Sincerely, [Provider Name / Billing Contact]
Need to resolve this denial?
Get a step-by-step resolution plan with payer-specific guidance and appeal letter generation.
Resolve this denial →