CARC 215 — Payment was adjusted based on a third-party settlement where the payer has subr

CARC 215OA · Other Adjustment

Payment was adjusted based on a third-party settlement where the payer has subrogation rights to recover costs.

Common causes: The injury involved a third party, such as an at-fault driver, and a settlement affects how the claim is paid pending subrogation recovery.
Suggested fix: Coordinate with the payer's subrogation department regarding the settlement status and any resulting claim reprocessing.

Related Other Adjustment codes

109This payer isn't responsible for this claim; it needs to be sent to a different payer or contractor.136The claim wasn't processed correctly because it didn't follow the rules or requirements set by a prior (primary) payer.140The member ID number submitted doesn't match the patient or subscriber name on file with the payer.18This claim or service line is an exact duplicate of one already submitted and processed.19The payer has determined this claim relates to a work injury or illness, making workers' compensation the responsible party instead.22The payer believes another insurance plan should be billed first or is otherwise responsible under coordination-of-benefits rules.23This adjustment reflects how a prior payer already processed the claim, reducing what this payer pays as a result.253Payment was reduced due to mandatory federal budget sequestration, a government-wide across-the-board cut applied to Medicare payments.

Frequently asked questions

What does CARC 215 mean?

Payment was adjusted based on a third-party settlement where the payer has subrogation rights to recover costs.

How do I resolve CARC 215?

Coordinate with the payer's subrogation department regarding the settlement status and any resulting claim reprocessing.

Why does CARC 215 happen?

The injury involved a third party, such as an at-fault driver, and a settlement affects how the claim is paid pending subrogation recovery.

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.