Eligibility / Coverage Denials
CARC 27CARC 204CARC 31The payer could not confirm the patient was covered on the date of service.
What it is
The pattern
An eligibility denial means coverage could not be confirmed for the date of service — either the patient genuinely had no coverage, or the member data on the claim (ID, name, DOB) did not match the payer's records.
Why it happens
Common causes
- Eligibility was verified on the wrong date — today's coverage was assumed for a past DOS.
- The member ID on the claim differs from the card (or the ID was typed wrong).
- The subscriber's name or DOB on file does not match what was submitted.
- Coverage terminated before the DOS and was never re-checked.
Prevention
Stop it before the claim goes out
- Verify eligibility for the exact date of service — not 'at check-in' and not 'today'.
- Scan the member card and key the ID, name and DOB exactly as printed.
- Re-verify when there is any gap between scheduling and service date.
When it happens
What to do
If the data was wrong, correct the member information and resubmit. If coverage existed but verification failed, appeal with the eligibility confirmation for the DOS. If the patient was genuinely not covered, bill per the applicable patient-responsibility rules.
Deeper dive
The full denial guide
Coverage could not be verified or was not active for the date of service — member not found, coverage lapsed, or eligibility requirements not met.
Open the Eligibility & Coverage guide →