CARC 22 — This care may be covered by another payer per coordination of benefits.

AR Guide workflow

Step-by-step: Coordination of Benefits

✓ Workflow verified Aug 15, 2026 · Verified via review of official sources and AR Guide practice testing — not payer policy. View the full guide

VerifySteps 1–11
1. Order of benefits for the patient
2. The primary payer's EOB or ERA
3. Which payer was billed first
4. COB information currently on file
5. Plan type (medical / dental / pharmacy)
6. CARC 22 / 23 and the accompanying remark code
7. Confirm the patient's insurance order of benefits
8. Check whether the primary payer has been billed and paid
9. Compare the primary payer's EOB or ERA with this adjustment
10. Verify COB information on file is current
11. Confirm the claim was submitted to the correct plan for the service
ActSteps 12–15
1. Bill the primary payer per the order of benefits
2. Resubmit the secondary claim with the primary's EOB or ERA attached
3. Update COB records if the coverage order has changed
4. If the secondary calculation looks wrong, request a recalculation with the primary EOB
Document & QASteps 16–21
1. The primary payer's EOB or ERA
2. Current COB information for the patient
3. Payer correspondence on the order of benefits
4. Verify COB order at eligibility check-in
5. Keep the primary's EOB with the account for secondary billing
6. Re-verify COB whenever the patient reports a coverage change

AR Guide explanation

What it means

This care may be covered by another payer under coordination of benefits.

AR Guide knowledge

Common denial category

Coordination of Benefits — Another plan may be primary, the primary's payment was not applied correctly, or the claim belongs with a different payer under COB rules.

AR Guide knowledge

Most common causes

Multiple insurance plans on file
Primary payer not billed first
COB information missing or stale

AR Guide knowledge

Action in your PM/EMR system

In your PM system: update the patient's insurance order of benefits, then bill the primary first. For a secondary claim, attach the primary's EOB/ERA and resubmit.

Illustrative scenario

Real-world example

A secondary claim was denied with CARC 22 because the primary had not been billed first. Billing the primary, then resubmitting the secondary with the primary's EOB, resolved it.

Example — not a claim about any specific payer or account.

AR Guide knowledge

What AR should verify

Confirm the patient's insurance order of benefits
Check whether the other payer has been billed
Verify COB information on file is current

AR Guide knowledge

Recommended action

Bill the primary payer per COB order
Update COB records if the coverage order has changed

Appeal template

No code-specific template yet

No downloadable template targets CARC 22 specifically. Browse all appeal letter templates — or follow the recommended workflow above.

Priority 2

Commonly paired RARCs

RARCs commonly accompany CARC 22 on the ERA/EOB. Select the one on your line to focus the workflow, or use the list as a lookup.

What RARC is on your ERA/EOB line?

RARCMA04Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
RARCN4Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.
RARCN479Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
RARCN480Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
RARCN36Claim must meet primary payer's processing requirements before we can consider payment.
RARCN130Consult plan benefit documents/guidelines for information about restrictions for this service.Pull the specific plan benefit document and quote the exact restriction in your appeal — a general appeal without the plan language rarely succeeds here.

Priority 3

Payer-specific nuance

How major payers handle this denial — what AR Guide has verified, and what you must confirm with the payer. We never publish payer handling we have not verified.

Medicare