Latency: <2ms Edge Availability: 99.99% Standard: ANSI 835 / WPC CARC Verified: Sep 2026 V8 Pure Compute

CARC 96 Denial Code (Non-Covered Charge(s)) | ANSI 835 EDI Spec

Q: What does CARC 96 mean on an 835 ERA?

CARC 96 signifies: "Non-covered charge(s). At least one Remark Code must be provided.". It explains why the payer did not pay the full billed charge.

Q: Can a provider balance-bill the patient for CARC 96?

Allowed only if patient executed an ABN/waiver of liability prior to service delivery.

Q: How do medical billing teams resolve and appeal CARC 96?

If an Advance Beneficiary Notice (ABN) or Notice of Non-Coverage was signed prior to service, bill the patient. Otherwise, review payer policy for coverage criteria.

Comprehensive healthcare EDI technical reference and denial resolution guide for Claim Adjustment Reason Code 96 (Non-Covered Charge(s)) under ANSI ASC X12 835 005010X221A1.

View Pricing & SLA → ⚡ Test in Live Workbench ← Back to Healthcare EDI ANSI X12 Parser API

Official Regulatory Standard & Verification Protocol Authority: Accredited Standards Committee X12 / HIPAA 5010 ↗

Direct Answer Capsule: Comprehensive healthcare EDI technical reference and denial resolution guide for Claim Adjustment Reason Code 96 (Non-Covered Charge(s)) under ANSI ASC X12 835 005010X221A1. Conforms strictly to ANSI ASC X12 Standards (005010) with zero cold-starts and deterministic edge verification.

Execution SLA

<2ms Edge (Cloudflare V8)

Governing Norm

ANSI 835 / WPC CARC

Active Standard

Sep 2026 Edition

Throughput Limit

512 KB / Payload

Data Privacy

100% In-Memory (Zero Store)

Interactive Edge Workbench

⚡ Live CARC 96 Denial Code (Non-Covered Charge(s)) | ANSI 835 EDI Spec Interactive Workbench

Test real-time validation and deterministic schema parsing for CARC 96 Denial Code (Non-Covered Charge(s)) | ANSI 835 EDI Spec directly in your browser. Sub-5ms Cloudflare edge execution with zero setup.

32KB Demo Cap 60 req/min Burst <2ms V8 Compute Zero Data Retention

input.x12 0 B

output.json demo-ready

Status: Ready

{
  "status": "Click 'Run Edge Parse' to test live on Global Edge Isolates..."
}

Specification & Structural Breakdown

Technical Rule Summary: Implementation conforms strictly to ANSI ASC X12 Standards (005010). Data ingestion is fully deterministic: identical inputs always produce bit-for-bit identical outputs without ambient side-effects.

Claim Adjustment Reason Code (CARC) 96 communicates: "Non-covered charge(s). At least one Remark Code must be provided.".

In ANSI X12 835 Electronic Remittance Advice (ERA) files, CARC 96 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*96*AMOUNT~.

Root Cause: The billed procedure or service is excluded from the subscriber’s health insurance benefit policy (e.g., cosmetic surgery, unapproved experimental devices).

Adjudication & Appeal Strategy: If an Advance Beneficiary Notice (ABN) or Notice of Non-Coverage was signed prior to service, bill the patient. Otherwise, review payer policy for coverage criteria.

Attribute	Value	Technical Guidance
Reason Code	CARC 96	Non-Covered Charge(s)
Standard Group Code	PR	Patient Responsibility
ANSI 835 Segment	CASPR96*AMOUNT~	Loop 2110 or Loop 2100
Balance Billing Patient	Allowed only if patient executed an ABN/waiver of liability prior to service delivery.	Compliance with billing regulations
Common RARCs	N386, N425, M127	Remittance Advice Remark Codes
Recommended Action	If an Advance Beneficiary Notice (ABN) or Notice of Non-Coverage was signed prior to service, bill the patient. Otherwise, review payer policy for coverage criteria.	Workflow for billing teams

Parsed JSON Response Model

The edge microservice transforms input payloads into strongly-typed hierarchical JSON envelopes with sub-5ms latency:

HTTP 200 JSON Response Envelope

{
  "transactionType": "835",
  "claimNumber": "CLM-2026-001",
  "adjudication": {
    "billedAmount": 500,
    "paidAmount": 0,
    "adjustments": [
      {
        "groupCode": "PR",
        "groupName": "Patient Responsibility",
        "reasonCode": "96",
        "reasonDescription": "Non-Covered Charge(s)",
        "adjustmentAmount": 500
      }
    ]
  }
}

Copy-Paste Integration Code (5 Languages)

Integrate CARC 96 Denial Code (Non-Covered Charge(s)) | ANSI 835 EDI Spec directly into your production application with native, zero-dependency code snippets in cURL, Node.js, Python, Go, and C#:

curl --request POST \
  --url "https://healthcare-edi-ansi-x12-parser-837p-835-271.stanzaapi.com/api/v1/x12/parse" \
  --header "Content-Type: application/json" \
  --header "x-api-key: YOUR_API_KEY" \
  --data '{
  "raw": "ISA*00*          *00*          *ZZ*SUBMITTER1     *ZZ*RECEIVER01     *260830*1200*^*00501*000000001*0*P*:~GS*HC*SENDER*RECEIVER*20260830*1200*1*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*CLAIM001*20260830*1200*CH~NM1*41*2*DR DOE CLINIC*****46*1234567890~PER*IC*SUPPORT*TE*8005551212~HL*1**20*1~NM1*85*2*DR DOE CLINIC*****XX*1992837465~HL*2*1*22*0~NM1*IL*1*SMITH*JANE****MI*W123456780~CLM*CLM001*150.00***11::1*Y*A*Y*Y~LX*1~SV1*HC:99213*150.00*UN*1***1~SE*11*0001~GE*1*1~IEA*1*000000001~"
}'

const response = await fetch("https://healthcare-edi-ansi-x12-parser-837p-835-271.stanzaapi.com/api/v1/x12/parse", {
  method: "POST",
  headers: {
    "Content-Type": "application/json",
    "x-api-key": process.env.API_KEY || "YOUR_API_KEY"
  },
  body: JSON.stringify({
  "raw": "ISA*00*          *00*          *ZZ*SUBMITTER1     *ZZ*RECEIVER01     *260830*1200*^*00501*000000001*0*P*:~GS*HC*SENDER*RECEIVER*20260830*1200*1*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*CLAIM001*20260830*1200*CH~NM1*41*2*DR DOE CLINIC*****46*1234567890~PER*IC*SUPPORT*TE*8005551212~HL*1**20*1~NM1*85*2*DR DOE CLINIC*****XX*1992837465~HL*2*1*22*0~NM1*IL*1*SMITH*JANE****MI*W123456780~CLM*CLM001*150.00***11::1*Y*A*Y*Y~LX*1~SV1*HC:99213*150.00*UN*1***1~SE*11*0001~GE*1*1~IEA*1*000000001~"
})
});

const data = await response.json();
console.log(data);

import requests
import json

url = "https://healthcare-edi-ansi-x12-parser-837p-835-271.stanzaapi.com/api/v1/x12/parse"
headers = {
    "Content-Type": "application/json",
    "x-api-key": "YOUR_API_KEY"
}
payload = {
    "raw": "ISA*00*          *00*          *ZZ*SUBMITTER1     *ZZ*RECEIVER01     *260830*1200*^*00501*000000001*0*P*:~GS*HC*SENDER*RECEIVER*20260830*1200*1*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*CLAIM001*20260830*1200*CH~NM1*41*2*DR DOE CLINIC*****46*1234567890~PER*IC*SUPPORT*TE*8005551212~HL*1**20*1~NM1*85*2*DR DOE CLINIC*****XX*1992837465~HL*2*1*22*0~NM1*IL*1*SMITH*JANE****MI*W123456780~CLM*CLM001*150.00***11::1*Y*A*Y*Y~LX*1~SV1*HC:99213*150.00*UN*1***1~SE*11*0001~GE*1*1~IEA*1*000000001~"
}

response = requests.post(url, json=payload, headers=headers)
print(response.json())

package main

import (
	"bytes"
	"fmt"
	"io"
	"net/http"
	"os"
)

func main() {
	url := "https://healthcare-edi-ansi-x12-parser-837p-835-271.stanzaapi.com/api/v1/x12/parse"
	payload := []byte(`{"raw":"ISA*00*          *00*          *ZZ*SUBMITTER1     *ZZ*RECEIVER01     *260830*1200*^*00501*000000001*0*P*:~GS*HC*SENDER*RECEIVER*20260830*1200*1*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*CLAIM001*20260830*1200*CH~NM1*41*2*DR DOE CLINIC*****46*1234567890~PER*IC*SUPPORT*TE*8005551212~HL*1**20*1~NM1*85*2*DR DOE CLINIC*****XX*1992837465~HL*2*1*22*0~NM1*IL*1*SMITH*JANE****MI*W123456780~CLM*CLM001*150.00***11::1*Y*A*Y*Y~LX*1~SV1*HC:99213*150.00*UN*1***1~SE*11*0001~GE*1*1~IEA*1*000000001~"}`)

	req, _ := http.NewRequest("POST", url, bytes.NewBuffer(payload))
	req.Header.Add("Content-Type", "application/json")
	req.Header.Add("x-api-key", os.Getenv("API_KEY"))

	res, err := http.DefaultClient.Do(req)
	if err != nil {
		panic(err)
	}
	defer res.Body.Close()
	body, _ := io.ReadAll(res.Body)
	fmt.Println(string(body))
}

using System;
using System.Net.Http;
using System.Text;
using System.Threading.Tasks;

class Program
{
    static async Task Main()
    {
        using var client = new HttpClient();
        client.DefaultRequestHeaders.Add("x-api-key", Environment.GetEnvironmentVariable("API_KEY") ?? "YOUR_API_KEY");

        var json = @"{""raw"":""ISA*00*          *00*          *ZZ*SUBMITTER1     *ZZ*RECEIVER01     *260830*1200*^*00501*000000001*0*P*:~GS*HC*SENDER*RECEIVER*20260830*1200*1*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*CLAIM001*20260830*1200*CH~NM1*41*2*DR DOE CLINIC*****46*1234567890~PER*IC*SUPPORT*TE*8005551212~HL*1**20*1~NM1*85*2*DR DOE CLINIC*****XX*1992837465~HL*2*1*22*0~NM1*IL*1*SMITH*JANE****MI*W123456780~CLM*CLM001*150.00***11::1*Y*A*Y*Y~LX*1~SV1*HC:99213*150.00*UN*1***1~SE*11*0001~GE*1*1~IEA*1*000000001~""}";
        var payload = new StringContent(json, Encoding.UTF8, "application/json");

        var response = await client.PostAsync("https://healthcare-edi-ansi-x12-parser-837p-835-271.stanzaapi.com/api/v1/x12/parse", payload);
        var content = await response.Content.ReadAsStringAsync();
        Console.WriteLine(content);
    }
}

Frequently Asked Questions & Technical Notes

What does CARC 96 mean on an 835 ERA?

CARC 96 signifies: "Non-covered charge(s). At least one Remark Code must be provided.". It explains why the payer did not pay the full billed charge.

Can a provider balance-bill the patient for CARC 96?

Allowed only if patient executed an ABN/waiver of liability prior to service delivery.

How do medical billing teams resolve and appeal CARC 96?

If an Advance Beneficiary Notice (ABN) or Notice of Non-Coverage was signed prior to service, bill the patient. Otherwise, review payer policy for coverage criteria.

Related Healthcare EDI ANSI X12 Parser API Formats

Explore sibling specifications and standards in the same developer cluster:

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CARC 96 Denial Code (Non-Covered Charge(s)) | ANSI 835 EDI Spec

⚡ Live CARC 96 Denial Code (Non-Covered Charge(s)) | ANSI 835 EDI Spec Interactive Workbench

Specification & Structural Breakdown

Parsed JSON Response Model

Copy-Paste Integration Code (5 Languages)

Frequently Asked Questions & Technical Notes

Related Healthcare EDI ANSI X12 Parser API Formats

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