CARC Code
104
Managed Care Withholding
The insurance plan has withheld a portion of the payment as part of their managed care contract terms. This is typically a predetermined percentage held back for quality metrics, risk pools, or performance incentives.
contractualHow to resolve this denial
Accept withholding per managed care contract terms
- 1
Review the remittance advice to confirm the adjustment amount is accurate
- 2
Verify the contractual write-off against your fee schedule
- 3
Post the adjustment to the patient account
- 4
Do not balance bill the patient for this contractual reduction
- 5
Document the adjustment in your billing system
▶✓ 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 CO-104 — stats, related codes, appeal template
99%
Recovery Rate
1-3 days
Avg. Resolution
Easy
Difficulty
Rare
Frequency
Payer-Specific Notes
How major payers handle CARC 104 by specialty.
UnitedHealthcare
Review UHC's online claim status tool for additional detail on this adjustment.
Common 835 Combinations
CARC 104 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
Generic appeal template for CARC 104 denials.
We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 104 indicating: "Managed care withholding.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.
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