Denial Code CARC 27: Expenses After Coverage Terminated

CARC 27 means the payer records coverage as terminated before the service date. It is worth verifying rather than writing off, because eligibility data is frequently wrong or lagging, and retroactive reinstatements and coordination-of-benefits errors put many of these claims back into a payable state.

What this denial means

The payer’s eligibility system shows the member was not covered on the date of service and denies on that basis.

Why it happens

Eligibility feeds lag and err constantly. The member may have had retroactive coverage, switched plans within the same payer, or the termination date in the system may simply be wrong. Coordination-of-benefits confusion also produces false terminations when the payer thinks another plan is primary.

The appeal angle that works

Verify actual eligibility for the date of service directly, not from the stale data that produced the denial. If coverage was in force, appeal with the eligibility confirmation. If another plan was primary, resolve the coordination of benefits and rebill in the correct order. Many of these are data errors, not real terminations.

Questions

The payer says coverage was terminated but the patient was covered. What do I do?

Verify actual eligibility for the date of service directly, since the denial often comes from stale or wrong eligibility data. If coverage was in force, appeal with the confirmation. If another plan was primary, fix the coordination of benefits and rebill in the correct order.