What does CARC 35 mean?

CARC 35 means "Lifetime benefit maximum has been reached.". The recommended action is: Verify lifetime max exhausted; bill patient for remaining balance.

How do I resolve CARC 35?

Verify patient eligibility via the payer's real-time eligibility portal Confirm the subscriber name and member ID match payer records exactly Check effective and termination dates of coverage If eligibility is confirmed, resubmit with corrected demographic information If coverage is confirmed inactive, discuss patient responsibility or secondary insurance

Can CARC 35 be appealed?

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

CARC Code

35

🔴 Hard Denial

Lifetime benefit maximum has been reached.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Rare

Frequency

Recommended Action

Verify lifetime max exhausted; bill patient for remaining balance

Step-by-Step Resolution

1
Verify patient eligibility via the payer's real-time eligibility portal
2
Confirm the subscriber name and member ID match payer records exactly
3
Check effective and termination dates of coverage
4
If eligibility is confirmed, resubmit with corrected demographic information
5
If coverage is confirmed inactive, discuss patient responsibility or secondary insurance

Payer-Specific Notes

How major payers handle CARC 35 in practice.

MetLife Dental

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

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