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Denial Code 12

CARC 12: The diagnosis is inconsistent with the provider type

This is a Claim Adjustment Reason Code (CARC). CARCs explain why a payer adjusted or denied a claim line and appear with a group code (CO, PR, OA, PI). Codes appear on the EOB / ERA after a claim is adjudicated.

Reference only — CARC/RARC are national code sets updated periodically. Verify against the current official list before acting on a denial or appeal.

Related CARC codes

9
The diagnosis is inconsistent with the patient's age
10
The diagnosis is inconsistent with the patient's gender
11
The diagnosis is inconsistent with the procedure
13
The date of death precedes the date of service
14
The date of birth follows the date of service
16
Claim/service lacks information or has submission/billing error(s)

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