CARC Code

2

🟡 Soft Denial

Coinsurance Amount

This code indicates the portion of the allowed amount that the patient is responsible for paying as coinsurance. Coinsurance is the percentage of covered services the patient owes after the deductible is met, based on their insurance plan.

patient responsibility
Resolution: 97%Easy difficulty1-3 days avg

How to resolve this denial

Bill patient for coinsurance percentage

  1. 1

    Confirm coinsurance percentage from patient's Summary of Benefits

  2. 2

    Verify the allowed amount used to calculate coinsurance

  3. 3

    Calculate patient responsibility: allowed amount × coinsurance %

  4. 4

    Issue patient statement for the coinsurance amount

  5. 5

    Do not bill more than the coinsurance shown on the EOB

Resolve this denial →
✓ Pre-action checklist — verify before contacting the payer
  1. Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.

  2. Verify the claim was submitted with correct patient eligibility and benefit information.

  3. Check if this denial applies to a specific line item or the entire claim.

More about PR-2 — stats, related codes, appeal template

97%

Recovery Rate

1-3 days

Avg. Resolution

Easy

Difficulty

Very Common

Frequency

Payer-Specific Notes

How major payers handle CARC 2 by specialty.

Blue Cross Blue Shield

In-network coinsurance varies by plan; verify tier at time of service

UnitedHealthcare

Out-of-network coinsurance can be significantly higher; inform patient proactively

Common 835 Combinations

CARC 2 most often appears with these Group Code + RARC combinations on 835 remittances.

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 2 denials.

We are notifying you of patient coinsurance responsibility in the amount of $[AMOUNT] for claim [CLAIM_NUMBER]. This represents [PERCENT]% of the allowed amount of $[ALLOWED] per your plan benefits.

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