CARC242ReferenceCurrentVerified Aug 15, 2026CARC 242
AR Guide Workflow
Eligibility & Coverage
Coverage could not be verified or was not active for the date of service — member not found, coverage lapsed, or eligibility requirements not met.
AR Guide explanation
What it means
Services were not provided by network or primary care providers.
AR Guide knowledge
Common denial category
Eligibility & Coverage — Coverage could not be verified or was not active for the date of service — member not found, coverage lapsed, or eligibility requirements not met.
AR Guide knowledge
Common causes
- Out-of-network provider used
- Required primary care referral not obtained
AR Guide knowledge
What AR should verify
- Confirm the provider's network status
- Check the plan's network requirements for the service
AR Guide knowledge
Recommended action
- Bill per the plan's out-of-network rules
- If the provider is in-network, appeal with network verification
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.