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

- **Canonical URL:** https://stanzaapi.com/tools/x12-parser/carc/carc-96-non-covered-charges
- **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) 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.

## Specification Matrix
| Attribute | Value | Technical Guidance |
| --- | --- | --- |
| Reason Code | CARC 96 | Non-Covered Charge(s) |
| Standard Group Code | PR | Patient Responsibility |
| ANSI 835 Segment | CAS*PR*96*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 |

## Standard JSON Response Model
```json
{
  "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
      }
    ]
  }
}
```

## Frequently Asked Questions & Edge Cases
### Q: What does CARC 96 mean on an 835 ERA?
**A:** 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?
**A:** 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?
**A:** 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.