CARC 22: This care may be covered by another payer per coordination of benefits.

CARC 22 appears on the 835 ERA (Electronic Remittance Advice) that the payer returns after claim adjudication. It explains a reduction, denial, or payment adjustment to your billing team. For your practice, the question is workflow: identify the pattern, route the denial to the right resolution path (rebill, appeal, write-off), and recover what's recoverable without burning RVU time on dead-end fights.

What CARC 22 means

The official X12 description is: “This care may be covered by another payer per coordination of benefits.”

In plain language: The carrier thinks another insurance plan should pay first (or jointly) and won't process until that's resolved.

Common scenarios

• Dual coverage (employer + spouse's employer)
• Medicare + supplemental
• Auto / workers' comp possibly responsible
• Birthday rule disagreement for child

Practice workflow for CARC X 22

Confirm your coordination of benefits with both carriers. If only one plan exists, file a COB update with the carrier. If two plans, get the primary to process first then resubmit to secondary.

ApprovalHelp auto-drafts the appeal letter against the right federal appeal-rights regulation (ACA §2719, ERISA §503, NSA §2799A, 42 CFR 422 Subpart M, or 42 CFR 438 Subpart F) for the patient's plan type, the payer's own coverage policy, and the relevant clinical guideline. Drafts route to the clinician for signature in under five minutes.

CARC 22 group codes explained

On the 835 ERA, CARC 22 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.