CARC Code
81
Discharges.
How to resolve this denial
Obtain retroactive authorization; submit appeal with clinical documentation
- 1
Pull the original authorization request and approval (if any)
- 2
Determine whether a retroactive authorization request is an option with this payer
- 3
Prepare clinical documentation supporting medical necessity for the service
- 4
Submit the retroactive authorization request through the payer portal
- 5
Submit a formal appeal once the authorization is obtained or denied
- 6
Document all communication with the payer in the patient account
▶✓ 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-81 — 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 81 by specialty.
Blue Cross Blue Shield
BCBS requires appeal submission within 180 days for most plans.
Appeal Letter Template
Generic appeal template for CARC 81 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 81 indicating: "Service not authorized.." 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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