CARC238ReferenceCurrentVerified Aug 15, 2026CARC 238
AR Guide Workflow
Patient Responsibility
The amount is the patient's responsibility under the plan — deductible, coinsurance, copayment, or a non-covered amount the patient may be billed.
AR Guide explanation
What it means
The claim spans eligible and ineligible periods of coverage; this reduction is for the ineligible period. Used with group code PR.
AR Guide knowledge
Common denial category
Patient Responsibility — The amount is the patient's responsibility under the plan — deductible, coinsurance, copayment, or a non-covered amount the patient may be billed.
AR Guide knowledge
Common causes
- Coverage began or ended mid-claim
- Claim spans a coverage gap
AR Guide knowledge
What AR should verify
- Determine the ineligible portion of the claim
- Confirm the coverage dates
AR Guide knowledge
Recommended action
- Bill the patient for the ineligible period per plan rules
- If the coverage dates are wrong, appeal with correct eligibility evidence
About this guidance: Note
AR Guide knowledge is general reference content written by our team — it is not payer-specific policy and never replaces the payer’s documentation or your contract. Always confirm specifics with the payer.