Official CARC description: “Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.” Here’s what it actually means, why it fires, and how to get the claim paid.
You billed an entity that says “not mine” — wrong Medicare MAC or jurisdiction, a Medicare Advantage member billed to original Medicare, or a carved-out service (behavioral, lab, transplant) owned by a subcontractor.
Liability group: CO = Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Re-run eligibility for the exact DOS — identify the entity that owns the benefit
Rebill the correct payer; note the original submission date for timely-filing protection
For carve-outs, the correct payer is in the eligibility response's service-type segments
Fix the insurance record so recurring visits stop bouncing
Rarely appealed — redirected. Exception: when the payer is WRONG about not owning the benefit (portal shows active coverage for the DOS); then appeal with the eligibility printout.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor. In practice: You billed an entity that says “not mine” — wrong Medicare MAC or jurisdiction, a Medicare Advantage member billed to original Medicare, or a carved-out service (behavioral, lab, transplant) owned by a subcontractor.
CO stands for Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Rarely appealed — redirected. Exception: when the payer is WRONG about not owning the benefit (portal shows active coverage for the DOS); then appeal with the eligibility printout.