How do I resolve a CO-61 denial?

Pull the original claim and review the denial reason and any RARC codes Research the payer's policy for CARC 61 to understand the basis for denial See full resolution steps at tryarceum.com.

Can I appeal a CO-61 denial?

Yes. Most CO-61 denials can be appealed within 60-180 days depending on payer. This is appealable if a second opinion was actually obtained but not properly documented or communicated to the payer at the time of the original claim submission. Use our free tool to generate an appeal letter.

CARC Code

61

🔴 Hard Denial

Second Surgical Opinion Not Obtained

The claim payment was reduced or denied because the patient did not get a required second opinion from another surgeon before the procedure. Some insurance plans require this for certain elective or non-emergency surgeries.

authorization

Resolution: 35%Hard difficulty21-45 days avg

How to resolve this denial

Which payer denied this claim?

Obtain second opinion documentation retroactively and appeal

1
Pull the original claim and review the denial reason and any RARC codes
2
Research the payer's policy for CARC 61 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

Resolve this denial →

▶✓ 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-61 — stats, related codes, appeal template

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Rare

Frequency

Payer-Specific Notes

How major payers handle CARC 61 by specialty.

Blue Cross Blue Shield

BCBS requires appeal submission within 180 days for most plans.

Appeal Letter Template

Generic appeal template for CARC 61 denials.

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 61 indicating: "Penalty for failure to obtain second surgical opinion.." 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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