CARC 107 appeal letter template — Related or Qualifying Claim/Service Not Identified
CARC 107 means the payer could not process the claim because it did not identify a related or qualifying claim/service (such as a primary procedure, staged service, or companion claim) that the submitted service depends on. This template helps appeal the denial by supplying the missing cross-reference information.
When to appeal vs. correct & resubmit
Appeal if the related/qualifying claim or service was in fact billed (by you or another provider) and you can supply the claim number, date of service, or procedure code that links the two, or if documentation shows the services are appropriately linked and payable together. Correct and resubmit instead if the related claim was never actually filed, if the linkage was a billing error, or if a corrected claim with the proper reference number can be submitted more quickly through standard resubmission.
Appeal letter template
Copy the template, replace every [bracketed] field with your details, and keep only the paragraph that fits your situation.
[Date] [Payer Name] Attn: Appeals Department [Payer Address] Re: Appeal of Claim Denial — CARC 107 (Related or Qualifying Claim/Service Not Identified) Patient Name: [Patient Name] Member ID: [Member ID] Claim #: [Claim #] Date(s) of Service: [DOS] Billed CPT/HCPCS: [CPT/HCPCS] Rendering Provider: [Provider Name, NPI] Dear Appeals Reviewer, This letter appeals the denial of the above claim under CARC 107, which indicates that the related or qualifying claim/service was not identified on this claim. We are submitting this appeal to provide the missing cross-reference and request reprocessing. The service(s) billed on this claim are directly related to the following claim/service, which we believe satisfies the payer's requirement for identification: - Related Claim #: [Claim #] - Related Date of Service: [DOS] - Related CPT/HCPCS Code: [CPT/HCPCS] - Rendering/Referring Provider: [Provider Name, NPI] Enclosed documentation supports that the services billed are clinically and/or procedurally connected to the referenced claim and should be considered together for adjudication. We respectfully request that [Payer Name] reprocess this claim with the related claim information now identified. If additional information, authorization details, or records are needed to complete this linkage, please contact our office at [Phone] or [Email] so we can promptly provide them. Thank you for your attention to this matter. We look forward to your review and response. Sincerely, [Provider Name, NPI] [Practice Name] [Phone] [Email]
What to attach
- Copy of the original Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) showing CARC 107
- Copy of the related/qualifying claim (claim form and remittance, if available)
- Operative report or treatment notes showing the clinical connection between the services
- Authorization or referral documentation, if applicable
- Itemized billing statement for both claims
- Any prior correspondence with the payer regarding claim linkage
Frequently asked questions
What does CARC 107 mean?
It means the payer needs information identifying a related or qualifying claim or service (e.g., a staged procedure, companion claim, or linked service) before it can process the current claim, and that information was missing or unclear on the submission.
What information should I include to fix this denial?
Identify the related claim number, date of service, and procedure code, and explain how the two services or claims are connected, supported by medical records if available.
Should I appeal or resubmit a corrected claim?
If the related claim exists and you can supply its reference details, a corrected claim resubmission may be faster than an appeal. Use an appeal if the payer requires additional documentation or clinical justification beyond a simple reference correction.
Does submitting this template guarantee the claim will be paid?
No. This template helps organize and submit the missing information, but outcomes depend on the payer's review and are never guaranteed.
More free billing tools: all appeal letters · denial codes · NCCI edits · Medicare fees
This template is for informational purposes only and does not constitute legal, billing, or coding advice. It is a general framework to be customized by qualified staff based on payer-specific policies and documentation. Use of this template does not guarantee that an appeal will be successful or that a denial will be overturned.
Run visits, billing, and appeals in one place
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free