CARC Code
245
Performance Program Withhold
The payer has withheld a portion of the payment as part of a provider performance program. This amount is being held back based on your participation in a quality or incentive-based program.
contractualHow to resolve this denial
Review EDI error report; correct all flagged fields and resubmit the 837 transaction
- 1
Pull the original claim and review the specific field flagged by the RARC code
- 2
Compare claim data against the patient's insurance card and eligibility response
- 3
Correct the identified field(s) in the practice management system
- 4
Resubmit the corrected claim via the payer portal or clearinghouse
- 5
Confirm receipt and track the corrected claim to 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 CO-245 — stats, related codes, appeal template
95%
Recovery Rate
3-7 days
Avg. Resolution
Easy
Difficulty
Occasional
Frequency
Payer-Specific Notes
How major payers handle CARC 245 by specialty.
UnitedHealthcare
Review UHC's online claim status tool for additional detail on this adjustment.
Appeal Letter Template
Generic appeal template for CARC 245 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 245 indicating: "Electronic claim submitted with errors.." 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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