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Denial Code 242

CARC 242: Services not provided by network/primary care providers

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

239
Claim spans eligible and ineligible periods of coverage. Rebill separate claims
240
The diagnosis is inconsistent with the patient's birth weight
241
Low Income Subsidy Co-payment Amount
243
Services not authorized by network/primary care providers
245
Provider performance program withhold
246
This non-payable code is for required reporting only

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