CARC 1 — The billed amount was applied to the patient's plan deductible instead of being p

CARC 1PR · Patient Responsibility

The billed amount was applied to the patient's plan deductible instead of being paid by the payer.

Common causes: The patient hasn't yet met their annual deductible, so this portion of the allowed amount shifts to their responsibility before insurance starts paying.
Suggested fix: Bill the patient for the deductible amount, or verify eligibility beforehand to set expectations. No further payer action is typically needed.

Related Patient Responsibility codes

119The patient has used up the maximum benefit allowed for this service within the applicable time period, such as an annual visit limit.167The specific diagnosis code(s) on this claim aren't covered under the patient's plan.177The patient doesn't currently meet the plan's eligibility criteria for this benefit.187This amount was or should be paid from the patient's consumer-directed spending account, such as an HSA or FSA, rather than by the payer.2This portion of the claim represents the patient's coinsurance share, the percentage of the allowed amount they are responsible for under their plan.200The service date falls within a period when the patient's coverage had lapsed.201The patient is responsible for this amount under a legal set-aside arrangement, commonly seen in workers' compensation Medicare Set-Aside cases, rather than the payer.202This charge is for a personal comfort or convenience item or service that isn't covered by the plan.

Frequently asked questions

What does CARC 1 mean?

The billed amount was applied to the patient's plan deductible instead of being paid by the payer.

How do I resolve CARC 1?

Bill the patient for the deductible amount, or verify eligibility beforehand to set expectations. No further payer action is typically needed.

Why does CARC 1 happen?

The patient hasn't yet met their annual deductible, so this portion of the allowed amount shifts to their responsibility before insurance starts paying.

CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.