CARC 275: Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered.
Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered.
CARC 275 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 275 means
The official X12 description is: “Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered.”
In plain language: Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered.
Practice workflow for CARC X 275
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 275 group codes explained
On the 835 ERA, CARC 275 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 275 mean?
Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. In plain language: Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered.
Is CARC 275 appealable?
CARC 275 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 275 appear under?
CARC 275 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 275 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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