How do I resolve a CO-275 denial?

Review the full denial on the 835 ERA for CARC 275: "Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered." Pull the original claim and all supporting documentation for the date of service. See full resolution steps at tryarceum.com.

Can I appeal a CO-275 denial?

CO-275 denials are generally not appealable. This represents legitimate patient responsibility determined by the prior payer during proper coordination of benefits, which is a contractual obligation rather than a processing error.

CARC Code

275

🟡 Soft Denial

Prior Payer Patient Responsibility Not Covered

The previous insurance company already determined that the patient owes this amount as their responsibility (such as a deductible or copay), and the current payer will not cover that patient-owed portion. The patient remains responsible for this balance.

patient responsibility

Resolution: 85%Easy difficulty3-7 days avg

How to resolve this denial

Which payer denied this claim?

Review and resolve CARC 275: Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered.

1
Review the full denial on the 835 ERA for CARC 275: "Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered."
2
Pull the original claim and all supporting documentation for the date of service.
3
Identify the specific data element, policy requirement, or documentation gap that triggered this adjustment.
4
Correct the identified issue — update claim data, gather missing documentation, or verify coverage details.
5
Resubmit as a corrected claim (frequency type 7) or file a written appeal with supporting documentation.
6
Follow up with the payer within 10-15 business days to confirm adjudication.

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▶✓ 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-275 — stats, related codes, appeal template

85%

Recovery Rate

3-7 days

Avg. Resolution

Easy

Difficulty

Rare

Frequency

Payer-Specific Notes

How major payers handle CARC 275 by specialty.

General

Confirm payer-specific policy for CARC 275 and submit corrected claim or appeal as appropriate.

Appeal Letter Template

Generic appeal template for CARC 275 denials.

Dear [Payer Name] Appeals Department, We are writing to appeal the denial of claim [CLAIM #] for patient [PATIENT NAME] (Member ID: [ID]) for services rendered on [DATE OF SERVICE]. The claim was denied with CARC 275: "Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered." We believe this denial is in error for the following reasons: [INSERT CLINICAL/ADMINISTRATIVE JUSTIFICATION] We respectfully request reconsideration and payment of this claim. Sincerely, [Provider Name / Billing Contact]

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