CARC 3PR · Patient Responsibility
A fixed co-payment amount required by the patient's plan was deducted from the payment for this service.
- Common causes
- The plan requires a flat dollar co-pay per visit or service type (e.g., $25 for a specialist visit), which is collected from the patient rather than paid by insurance.
- Suggested fix
- Collect the co-pay from the patient, ideally at time of service; verify the correct co-pay tier if the amount doesn't match the insurance card.
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.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.
Frequently asked questions
What does CARC 3 mean?
A fixed co-payment amount required by the patient's plan was deducted from the payment for this service.
How do I resolve CARC 3?
Collect the co-pay from the patient, ideally at time of service; verify the correct co-pay tier if the amount doesn't match the insurance card.
Why does CARC 3 happen?
The plan requires a flat dollar co-pay per visit or service type (e.g., $25 for a specialist visit), which is collected from the patient rather than paid by insurance.
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.