CARC 216PI · Payer Initiated
Payment was adjusted based on a utilization review or peer review organization's findings about the service.
- Common causes
- A quality or utilization review organization examined the claim and made a determination affecting payment.
- Suggested fix
- Request the specific findings from the review organization and appeal if you disagree, with supporting clinical documentation.
Related Payer Initiated codes
Frequently asked questions
What does CARC 216 mean?
Payment was adjusted based on a utilization review or peer review organization's findings about the service.
How do I resolve CARC 216?
Request the specific findings from the review organization and appeal if you disagree, with supporting clinical documentation.
Why does CARC 216 happen?
A quality or utilization review organization examined the claim and made a determination affecting payment.
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.