CARC Code
28
Coverage not in effect at the time the service was provided.
How to resolve this denial
Verify coverage dates; bill patient if confirmed gap
- 1
Verify patient eligibility via the payer's real-time eligibility portal
- 2
Confirm the subscriber name and member ID match payer records exactly
- 3
Check effective and termination dates of coverage
- 4
If eligibility is confirmed, resubmit with corrected demographic information
- 5
If coverage is confirmed inactive, discuss patient responsibility or secondary insurance
▶✓ 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-28 — 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 28 by specialty.
Blue Cross Blue Shield
BCBS requires appeal submission within 180 days for most plans.
Appeal Letter Template
Generic appeal template for CARC 28 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 28 indicating: "Coverage not in effect at the time the service was provided.." 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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