CARC 109: Not covered by this payer, send to the correct payer
This payer is not responsible for the claim. Another payer or contractor should get it.
Group code context
Often sent with group code CO.
Common causes
- Medicare Advantage patient billed to traditional Medicare
- Wrong Medicare contractor (MAC) or DME claim sent to the Part B contractor
- Patient has a Medicaid managed care plan, not straight Medicaid
Step-by-step fix
- Find the right payer through eligibility
- Update the patient's insurance in the PM system
- Send the claim to the right payer quickly, because the filing limit is still running
Appeal guidance
Rarely an appeal. Rebill the right payer.
When not to appeal
Do not appeal to the wrong payer. Spend the time rebilling.
Prevention checklist
- Check plan type (Medicare Advantage, managed Medicaid) at registration
- Keep payer IDs current in the clearinghouse
Related codes
CARC 22: May be covered by another payer (coordination of benefits)
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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.