CARC 200PR · Patient Responsibility
The service date falls within a period when the patient's coverage had lapsed.
- Common causes
- A gap in coverage occurred, often due to a missed premium payment that was later reinstated, leaving a lapse period in between.
- Suggested fix
- Confirm the lapse dates with the payer; if coverage was later reinstated retroactively, ask the payer to reprocess, otherwise bill the patient for services during the lapse.
Related Patient Responsibility codes
1The billed amount was applied to the patient's plan deductible instead of being paid by the payer.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.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 200 mean?
The service date falls within a period when the patient's coverage had lapsed.
How do I resolve CARC 200?
Confirm the lapse dates with the payer; if coverage was later reinstated retroactively, ask the payer to reprocess, otherwise bill the patient for services during the lapse.
Why does CARC 200 happen?
A gap in coverage occurred, often due to a missed premium payment that was later reinstated, leaving a lapse period in between.
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.