AGAR Guide
CARC254ReferenceCurrentVerified Aug 15, 2026

CARC 254

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

  1. 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

  2. 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

  3. 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

The claim was received by the dental plan but benefits are not available under it. Submit the services to the patient's medical plan.

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

  • Service billed to the wrong plan type
  • Dental plan does not cover the service

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

  1. Confirm the service belongs under the medical benefit

AR Guide knowledge

Recommended action

  1. Submit to the correct medical plan

Appeal template

No code-specific template yet

No downloadable template targets CARC 254 specifically. Browse all appeal letter templates — or follow the recommended workflow above.

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.

Priority 2

Commonly paired RARCs

RARCs commonly accompany CARC 254 on the ERA/EOB. Select the one on your line to focus the workflow, or use the list as a lookup.

  • RARCN387Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.
  • 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

Coordination-of-benefits rules and the order-of-benefits determination are payer- and plan-specific. Confirm the correct order with the payers involved and attach the primary's EOB to secondary claims.

Medicaid

Coordination-of-benefits rules and the order-of-benefits determination are payer- and plan-specific. Confirm the correct order with the payers involved and attach the primary's EOB to secondary claims.

UnitedHealthcare

Coordination-of-benefits rules and the order-of-benefits determination are payer- and plan-specific. Confirm the correct order with the payers involved and attach the primary's EOB to secondary claims.

Aetna

Coordination-of-benefits rules and the order-of-benefits determination are payer- and plan-specific. Confirm the correct order with the payers involved and attach the primary's EOB to secondary claims.

Cigna

Coordination-of-benefits rules and the order-of-benefits determination are payer- and plan-specific. Confirm the correct order with the payers involved and attach the primary's EOB to secondary claims.

Anthem (BCBS)

Coordination-of-benefits rules and the order-of-benefits determination are payer- and plan-specific. Confirm the correct order with the payers involved and attach the primary's EOB to secondary claims.

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