CARC213ReferenceCurrentVerified Aug 15, 2026CARC 213
Check the remark code — then triage: Note
For less common codes, the accompanying remark code (RARC) is what tells you whether this is a correction, an appeal, a documentation request, or a no-action item.
If you take the wrong path: Working from the CARC alone instead of the CARC + RARC pair is how the wrong path gets chosen.
AR Guide explanation
What it means
Non-compliance with the physician self-referral prohibition legislation or payer policy.
AR Guide knowledge
Common denial category
AR Guide knowledge
Most common causes
- Stark law or self-referral concerns
- Referral relationship not documented
AR Guide knowledge
Action in your PM/EMR system
In your PM system: open the claim and note the remark code in the account. Triage against the denial guides before choosing a resubmission, appeal, or write-off path.
Illustrative scenario
Real-world example
For uncommon codes, the remark code is the map: read the CARC + RARC together, triage it against the denial guides, and only then choose correct, appeal, or write-off.
Example — not a claim about any specific payer or account.
AR Guide knowledge
What AR should verify
- Review the referral arrangement for compliance
- Gather documentation of the referral relationship
AR Guide knowledge
Recommended action
- Appeal with compliance documentation if the arrangement is proper
- Correct the arrangement if non-compliant
Appeal template
No code-specific template yet
No downloadable template targets CARC 213 specifically. Browse all appeal letter templates — or follow the recommended workflow above.
About this guidance: Note
Priority 2
Commonly paired RARCs
RARCs commonly accompany CARC 213 on the ERA/EOB. Select the one on your line to focus the workflow, or use the list as a lookup.
RARCN55Procedures for billing with group/referring/performing providers were not followed.
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