Integration Pattern

Post-Denial Resolution

When a denial comes back through an ERA (835) or claim status response (277), decode the CARC/RARC codes, surface the payer's filing and appeal deadlines, and route each one to the right next step.

For: Denial management companies, AI RCM platforms, billing companies

Denial decoding is in preview over the API. The Remit Explorer already decodes 835s in the browser today.

How it works

architecture flow

ERA (835) / Claim Status (277) received
  │
  ├─ Parse CARC and RARC codes from the denial
  │
  ├─ Call RCIntel
  │   ├─ /v1/payers/denial-codes/{code}    Plain-English meaning + category
  │   └─ /v1/payers/{slug}/filing-deadline Appeal / filing window
  │
  ├─ Decoded denial returned
  │   ├─ Route to the right work queue
  │   └─ Your system builds the correction or appeal
  │
  └─ Resubmit corrected claim or file appeal

Code example

python

import httpx

async def decode_denial(api_key: str, denial: dict) -> dict:
    async with httpx.AsyncClient(
        base_url="https://api.your-domain.com",
        headers={"X-API-Key": api_key},
    ) as client:
        # Plain-English meaning + category for the adjustment code
        code = (await client.get(
            f"/v1/payers/denial-codes/{denial['carc']}"
        )).json()

        # Payer's appeal / filing window
        filing = (await client.get(
            f"/v1/payers/{denial['payer_slug']}/filing-deadline"
        )).json()

    return {
        "carc": denial["carc"],
        "meaning": code.get("description"),
        "category": code.get("category"),
        "appeal_days": filing.get("appeal_days"),
    }

Common denials, decoded

The API returns the meaning and category; the work-it column is a starting point your team can build on.

CARC 197

Precertification/authorization absent

Request retroactive auth, then appeal with clinical documentation

CARC 50

Non-covered service

Validate against the applicable NCD/LCD, appeal with supporting criteria

CARC 16

Missing/incomplete information

Identify the missing fields, resubmit with corrections

CARC 29

Time limit for filing expired

Check whether an exception applies (e.g., retroactive eligibility), file the exception request

CARC 182

Procedure inconsistent with POS

Confirm the correct place of service for the facility, resubmit

CARC 4

Procedure inconsistent with modifier

Check the modifier requirements for the code pair, resubmit

Decode denials programmatically

Get a free read-only key to start, or open the Remit Explorer to decode an 835 in the browser right now.

Get an API key Open Remit Explorer