CARC 256CO · Contractual Obligation
This service isn't payable under the specific terms of the patient's managed care contract.
- Common causes
- The managed care agreement excludes or specifically doesn't reimburse this service type.
- Suggested fix
- Review the managed care contract terms for this service; confirm whether it should be billed to a different entity, such as a capitated group.
Related Contractual Obligation codes
107This claim depends on another related claim or service being referenced, but that link wasn't provided.11The diagnosis code doesn't support medical necessity for the procedure billed, based on the payer's coverage edits.13The claim shows a date of service after the patient's recorded date of death.146The diagnosis code billed wasn't a valid, active code as of the date of service.150The documentation submitted doesn't justify the complexity or level of the service billed, commonly seen with evaluation and management visit levels.16The claim is missing required information or contains a billing error that prevented the payer from processing it.170This payer doesn't reimburse this specific provider type for this service.171This payer doesn't cover this service when it's billed by this provider type in this particular facility setting.
Frequently asked questions
What does CARC 256 mean?
This service isn't payable under the specific terms of the patient's managed care contract.
How do I resolve CARC 256?
Review the managed care contract terms for this service; confirm whether it should be billed to a different entity, such as a capitated group.
Why does CARC 256 happen?
The managed care agreement excludes or specifically doesn't reimburse this service type.
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.