CARC 247: Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
CARC 247 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 247 means
The official X12 description is: “Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.”
In plain language: Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
Practice workflow for CARC X 247
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 247 group codes explained
On the 835 ERA, CARC 247 appears alongside a group code that signals who is financially responsible for the adjustment. PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
Frequently asked questions
What does CARC 247 mean?
Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim. In plain language: Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
Is CARC 247 appealable?
CARC 247 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Which group code does CARC 247 appear under?
CARC 247 most often appears under: PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
What should I do if I see CARC 247 on the 835?
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Related resources
Sources
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