What does CARC 38 mean?

CARC 38 means "Services not provided or authorized by designated (network/primary care) providers.". The recommended action is: Verify network status; obtain retroactive authorization if possible.

How do I resolve CARC 38?

Pull the original claim and review the denial reason and any RARC codes Research the payer's policy for CARC 38 to understand the basis for denial Gather supporting documentation addressing the denial reason Submit a formal appeal with the documentation within the plan's appeal window Follow up on the appeal within 30 days and document all communication

Can CARC 38 be appealed?

CARC 38 has a 35% recovery rate and typically resolves in 21-45 days. Resolution difficulty is rated Hard.

CARC Code

38

🔴 Hard Denial

Services not provided or authorized by designated (network/primary care) providers.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Recommended Action

Verify network status; obtain retroactive authorization if possible

Step-by-Step Resolution

1
Pull the original claim and review the denial reason and any RARC codes
2
Research the payer's policy for CARC 38 to understand the basis for denial
3
Gather supporting documentation addressing the denial reason
4
Submit a formal appeal with the documentation within the plan's appeal window
5
Follow up on the appeal within 30 days and document all communication

Payer-Specific Notes

How major payers handle CARC 38 in practice.

MetLife Dental

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

Common 835 Combinations

CARC 38 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-38Appealable

Look up any combination →

Appeal Letter Template

Enter your email to access the full appeal template for CARC 38.

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 38 indicating: "Services not provided or authorized by designated (network/primary care) provide." 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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