CARC Code
52
The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
How to resolve this denial
Verify provider eligibility and enrollment status; correct referral if needed
- 1
Verify the rendering or referring provider's enrollment status with this payer
- 2
Check that the provider's NPI, taxonomy, and license are current and active
- 3
If the provider is not enrolled, initiate enrollment before resubmitting
- 4
Obtain a re-referral or re-order from an enrolled, eligible provider if needed
- 5
Resubmit the claim with the correct enrolled provider information
▶✓ 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-52 — 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 52 by specialty.
Blue Cross Blue Shield
BCBS requires appeal submission within 180 days for most plans.
Appeal Letter Template
Generic appeal template for CARC 52 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 52 indicating: "The referring/prescribing/rendering provider is not eligible to refer/prescribe/." 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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