CARC Code
98
The hospital must file the Medicare claim for this inpatient non-physician service.
How to resolve this denial
Coordinate with facility to submit the claim under the institutional provider
- 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-98 — stats, related codes, appeal template
99%
Recovery Rate
1-3 days
Avg. Resolution
Medium
Difficulty
Rare
Frequency
Payer-Specific Notes
How major payers handle CARC 98 by specialty.
UnitedHealthcare
Review UHC's online claim status tool for additional detail on this adjustment.
Appeal Letter Template
Generic appeal template for CARC 98 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 98 indicating: "The hospital must file the Medicare claim for this inpatient non-physician servi." 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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