# CARC 27 Denial Code (Expenses Incurred After Coverage Terminated) | ANSI 835 EDI Spec
> Comprehensive healthcare EDI technical reference and denial resolution guide for Claim Adjustment Reason Code 27 (Expenses Incurred After Coverage Terminated) under ANSI ASC X12 835 005010X221A1.

- **Canonical URL:** https://stanzaapi.com/tools/x12-parser/carc/carc-27-coverage-terminated
- **Governing Standard:** ANSI ASC X12 Standards (005010) (Accredited Standards Committee X12 / HIPAA 5010)
- **Edge Latency SLA:** <2ms Edge (Cloudflare V8 Isolates)
- **Execution Model:** Pure compute $f(x) = y$, 100% In-Memory (Zero Store, Zero Log)

## Technical Overview & Governing Rules
Claim Adjustment Reason Code (CARC) 27 communicates: "Expenses incurred after coverage terminated.".

In ANSI X12 835 Electronic Remittance Advice (ERA) files, CARC 27 is reported in Loop 2110 (Service Payment Information) or Loop 2100 (Claim Payment Information) under the Claim Adjustment (CAS) segment with Group Code 'PR' (Patient Responsibility), formatted as: CAS*PR*27*AMOUNT~.

Root Cause: The patient’s health plan policy was inactive or terminated on the date of service.

Adjudication & Appeal Strategy: Request updated insurance details from patient or verify eligibility across other payers via ANSI 270. If no other coverage was active, bill patient as self-pay.

## Specification Matrix
| Attribute | Value | Technical Guidance |
| --- | --- | --- |
| Reason Code | CARC 27 | Expenses Incurred After Coverage Terminated |
| Standard Group Code | PR | Patient Responsibility |
| ANSI 835 Segment | CAS*PR*27*AMOUNT~ | Loop 2110 or Loop 2100 |
| Balance Billing Patient | Allowed — patient was uninsured with this plan on date of service. | Compliance with billing regulations |
| Common RARCs | MA04, N30 | Remittance Advice Remark Codes |
| Recommended Action | Request updated insurance details from patient or verify eligibility across other payers via ANSI 270. If no other coverage was active, bill patient as self-pay. | Workflow for billing teams |

## Standard JSON Response Model
```json
{
  "transactionType": "835",
  "claimNumber": "CLM-2026-001",
  "adjudication": {
    "billedAmount": 500,
    "paidAmount": 0,
    "adjustments": [
      {
        "groupCode": "PR",
        "groupName": "Patient Responsibility",
        "reasonCode": "27",
        "reasonDescription": "Expenses Incurred After Coverage Terminated",
        "adjustmentAmount": 500
      }
    ]
  }
}
```

## Frequently Asked Questions & Edge Cases
### Q: What does CARC 27 mean on an 835 ERA?
**A:** CARC 27 signifies: "Expenses incurred after coverage terminated.". It explains why the payer did not pay the full billed charge.

### Q: Can a provider balance-bill the patient for CARC 27?
**A:** Allowed — patient was uninsured with this plan on date of service.

### Q: How do medical billing teams resolve and appeal CARC 27?
**A:** Request updated insurance details from patient or verify eligibility across other payers via ANSI 270. If no other coverage was active, bill patient as self-pay.