Denial Risk Checker

Select or describe a billing scenario to review common DMEPOS denial themes.

Important: Fee schedule amounts and code references do not guarantee coverage or payment. Verify billing decisions with official Medicare sources, DME MAC guidance, and qualified compliance professionals.

Do not include names, MBIs, diagnoses, addresses, or other patient-identifying information.

Enter a HCPCS code, documentation facts, replacement timing, or modifier details for a more targeted ranking.

CARC 16: Missing or Invalid Claim Information

General check

CARC 16 is a broad signal that required claim information is missing, incomplete, invalid, or inconsistent. The associated RARC and claim-level context identify the actual field or relationship to fix.

Validate required claim loops, provider roles, identifiers, diagnosis pointers, modifiers, units, charges, and payer-specific companion-guide edits before release.

Open resolution guide

CARC 18: Duplicate Claim or Service

General check

A duplicate adjustment means the payer believes the same service was already submitted or adjudicated. The correct action depends on whether the prior claim is paid, pending, denied, voided, or materially different.

Lock resubmission while a claim is pending, reconcile clearinghouse and payer claim IDs, and require replacement or void indicators for true corrections.

Open resolution guide

CARC 22: Coordination of Benefits and Payer Order

General check

This denial family commonly indicates that another payer may have primary responsibility or that primary-payer adjudication data is missing or inconsistent.

Ask current coverage and employment questions, verify payer order for the date of service, and transmit complete primary adjudication data on secondary claims.

Open resolution guide