Claim adjustment reason code
Denial code CO-242 meaning
CARC 242, usually seen as CO-242: The plan pays only when a network or primary care provider gives the service.
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- Reason code
- CARC 242
- Short name
- Not by a network or primary care provider
- Plain meaning
- The plan pays only when a network or primary care provider gives the service.
- Group codes
- CO-242: Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it.
Plain-English summary written by Rivvi. X12 owns the CARC list and its exact wording, which is not reproduced here. Read it on the X12 CARC list (list dated November 1, 2025, checked October 23, 2026). This page does not decide how a claim is paid.
Common causes
- The provider is out of network for an HMO or EPO plan.
What to check before resubmitting
- Check network status for the plan.
- Get a referral or an authorization for out-of-network care.
Related reason codes
Related pages
Questions
What does denial code CO-242 mean?
The plan pays only when a network or primary care provider gives the service. This is Rivvi's plain-English summary of CARC 242. X12's exact wording is on x12.org.
How do I fix CO-242?
Check network status for the plan. Get a referral or an authorization for out-of-network care.
Can I bill the patient for CO-242?
With group code CO, no. CO means the provider absorbs the amount under its contract or the payer's rules.
Which group codes come with CARC 242?
Most often CO (contractual obligation). The group code, not the reason code, says who owes the amount.
What is the difference between a CARC and a RARC?
A claim adjustment reason code (CARC) says why a claim line was paid differently than billed. A remittance advice remark code (RARC) adds detail, such as which field is missing.