CARC Code
1
Deductible Amount
The patient has not yet met their annual deductible, so they are responsible for paying this portion of the claim before insurance coverage begins.
patient responsibilityHow to resolve this denial
Bill patient for deductible amount
- 1
Verify patient's deductible status and year-to-date accumulation
- 2
Cross-reference with the plan's Explanation of Benefits
- 3
Bill patient for the deductible amount shown on the EOB
- 4
Document deductible balance in patient account
- 5
Send patient statement within 30 days of claim adjudication
▶✓ Pre-action checklist — verify before contacting the payer
Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.
▶More about PR-1 — stats, related codes, appeal template
95%
Recovery Rate
1-3 days
Avg. Resolution
Easy
Difficulty
Very Common
Frequency
Payer-Specific Notes
How major payers handle CARC 1 by specialty.
UnitedHealthcare
Deductible may be family or individual; confirm which applies before billing patient
Aetna
High-deductible health plans (HDHP) may result in larger patient responsibility
Common 835 Combinations
CARC 1 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
Generic appeal template for CARC 1 denials.
This letter confirms patient responsibility for the deductible amount of $[AMOUNT] applied to claim [CLAIM_NUMBER] for services rendered on [DOS]. Per the patient's benefit summary, the annual deductible of $[DEDUCTIBLE] has accumulated $[YTD_AMOUNT] year-to-date.
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