Denial code

CARC 109 denial code: meaning & whether to appeal

CARC 109: the exact X12 wording, how it is classified, and whether it is worth appealing.

Appealant EditorialX12 verified3 min read

What CARC 109 means

Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.

Verbatim description from the official X12 Claim Adjustment Reason Codes list.

Classification

Denial class: coordination of benefits

Appealability verdict

Appealable — coordination of benefits

What to know

Usually resolved by establishing the correct order of benefits — the other carrier's explanation of benefits and current coverage records are the key documents.

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