Official CARC description: “Expenses incurred after coverage terminated.” Here’s what it actually means, why it fires, and how to get the claim paid.
Same fact pattern as CO 27 but the payer routed liability to the patient. Verify termination is real before statements go out — wrongly PR'd termination denials create patient complaints and refunds.
Liability group: PR = Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Re-verify eligibility and hunt for the successor plan
Bill the new plan with original-submission proof for timely filing
Marketplace plans: check the premium grace-period rules — claims in month 1 of grace must be paid
Confirmed termination: patient statements with clear DOS/coverage explanation
Appeal marketplace grace-period denials (month-one claims are payer liability by regulation) and any termination contradicted by a verified 271. Attach the verification records.
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.
Expenses incurred after coverage terminated. In practice: Same fact pattern as CO 27 but the payer routed liability to the patient. Verify termination is real before statements go out — wrongly PR'd termination denials create patient complaints and refunds.
PR stands for Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Appeal marketplace grace-period denials (month-one claims are payer liability by regulation) and any termination contradicted by a verified 271. Attach the verification records.