CARC Code
238
Coverage Gap Adjustment
The services you received fell partly during a time when you had coverage and partly when you didn't. The payer reduced the payment for the portion that happened when coverage was inactive.
eligibilityHow to resolve this denial
Submit appeal with proof of timely filing; review contract filing deadline
- 1
Pull submission logs from your clearinghouse or payer portal
- 2
Gather all proof of timely filing: submission confirmation, rejection notices, prior payments
- 3
Submit a formal appeal with timely filing evidence attached
- 4
If proof is insufficient, review internal workflows to prevent future occurrences
- 5
Document the appeal and set a follow-up reminder for 30 days
▶✓ 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-238 — stats, related codes, appeal template
35%
Recovery Rate
21-45 days
Avg. Resolution
Hard
Difficulty
Occasional
Frequency
Payer-Specific Notes
How major payers handle CARC 238 by specialty.
UnitedHealthcare
UHC allows 180 days from DOS for most commercial plans. Check specific plan filing window.
Appeal Letter Template
Generic appeal template for CARC 238 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 238 indicating: "Claim received after the Plan's contractual filing deadline.." 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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