CARC 26: Service before coverage started
The date of service is before the patient's coverage began.
Group code context
Often sent with group code PR, since the patient had no coverage with this plan on that date.
Common causes
- New plan not active yet on the date of service
- Wrong date of service on the claim
Step-by-step fix
- Check the effective date on eligibility
- Correct the date of service if it was wrong
- Find the plan that was active on that date and bill it
- If there was no coverage, bill the patient
Appeal guidance
Appeal only if the coverage dates on file are wrong and the patient can show proof of coverage.
When not to appeal
Do not appeal if the patient was not covered that day.
Prevention checklist
- Run eligibility before every visit, not only at the first one
- Re-check eligibility at the start of each year
Related codes
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Source and review
Official source ↗Last checked: 2026-10-05
Reviewed by: PracticeVendors editorial team
Educational reference. Confirm payer instructions and applicable contracts before taking action.