Denial Next Step and Deadline
What to do next about a claim denial, and by when.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Group code
- CO (contractual obligation)
- Claim adjustment reason code
- 50
- Payer type
- Original Medicare
- Remittance date
- 2026-09-01
Result: CO-50: Medical necessity or coverage. Appeal with the medical records that support the service. Appeal by January 4, 2027: redetermination within 120 days of receiving the notice, presumed 5 days after its date (42 CFR 405.942).
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Group code
- Claim adjustment reason code (the number)
- Payer type
- Remittance date (YYYY-MM-DD)
- Date of service (YYYY-MM-DD)
- Appeal window for Medicaid or other payers
How this is calculated
Citation
An original mapping of reviewed CARC codes (active on x12.org) to next steps; deadlines from 42 CFR 405.942 (120 days), 422.582 and 423.582 (60 days), 29 CFR 2560.503-1 and 45 CFR 147.136 (180 days), and 42 CFR 424.44 (1 year) for a corrected Medicare claim. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.