CARC272ReferenceCurrentVerified Aug 15, 2026CARC 272
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
Coverage or program guidelines were not met.
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
- Service does not meet coverage criteria
- Program requirement not satisfied
AR Guide knowledge
What AR should verify
- Review the coverage guideline cited
- Confirm the documentation meets the criteria
AR Guide knowledge
Recommended action
- Appeal with documentation showing the criteria are met
- If criteria are not met, adjust per the guidelines
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.