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E/M level reduced (downcoded)
The payer paid a level 4 or 5 office visit at a lower level (for example, Aetna's Claim & Code Review or Cigna's R49 policy). Usually shows as CARC 150.
Coverage or medical necessity denial
The payer says the service wasn't medically necessary or the diagnosis isn't covered (CARC 50, 151 or 167, often with RARC N115 or N386).
Authorization was approved
The claim was denied for a missing, invalid or exceeded authorization, but you have an approval that covers the service (CARC 197 or 198).
Filed on time (timely filing)
The claim was denied as late (CARC 29), but a clearinghouse or payer report shows the original claim was accepted within the filing limit.
Payer Deadline Sheet
Appeal and timely filing windows for 7 payers on one printable page.