CARC 170 appeal letter template — Payment Denied Based on Provider Type
CARC 170 means the payer denied payment because the service was performed or billed by a provider type it does not recognize or allow for that service; an appeal is appropriate when the biller believes the provider type is eligible or the denial is based on a data error.
When to appeal vs. correct & resubmit
Appeal when the rendering/billing provider type is, in fact, eligible to perform and bill this service under the payer's policy, the provider's taxonomy/specialty on file is incorrect, or the claim was billed under the wrong provider/NPI by mistake. If the provider type genuinely is not eligible to bill this service under the payer's rules, correct the claim (e.g., bill under a supervising/eligible provider, per applicable incident-to or scope-of-practice rules) and resubmit instead of appealing.
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] Appeals Department [Payer Address] Re: Appeal of Claim Denial — CARC 170 (Payment is denied when performed/billed by this type of provider) Patient Name: [Patient Name] Member ID: [Member ID] Claim #: [Claim #] Date(s) of Service: [DOS] Billing/Rendering Provider: [Provider Name, NPI] CPT/HCPCS: [CPT/HCPCS] Dear Appeals Reviewer, This letter appeals the denial of the above claim under CARC 170, which indicates payment was denied because the service was performed or billed by this type of provider. We respectfully request reconsideration for the following reason(s): [Describe why the provider type is eligible to bill this service — e.g., correct taxonomy, applicable scope of practice, supervising arrangement, or credentialing status. State any data entry error if the provider type on file is inaccurate.] Enclosed please find supporting documentation, including [list of attached records], which we believe demonstrates that the service rendered by [Provider Name, NPI] on [DOS] is eligible for reimbursement under [Payer Name]'s coverage policies for this provider type. We ask that [Payer Name] review the enclosed information and reprocess claim [Claim #] for payment. If any additional information or documentation (e.g., credentialing records, authorization number [Authorization #]) is needed to complete this review, please contact our office at [Phone] or [Email]. Thank you for your prompt attention to this matter. Sincerely, [Provider Name, NPI] [Practice Name] [Phone] [Email]
What to attach
- Original EOB/ERA showing the CARC 170 denial
- Provider credentialing/enrollment documentation verifying provider type and specialty
- Proof of correct taxonomy code or NPI registration
- Documentation of supervising provider arrangement, if applicable (e.g., incident-to billing records)
- Medical records supporting the service rendered
- Any prior authorization documentation (Authorization #), if relevant
Frequently asked questions
What does CARC 170 mean?
It means the payer denied payment because the specific type of provider who performed or billed the service is not recognized or eligible for reimbursement for that service under the payer's rules.
Should I appeal or resubmit a corrected claim for CARC 170?
If the provider type is actually eligible and the denial resulted from a data or enrollment error, appeal with supporting documentation. If the provider type truly cannot bill the service under payer rules, correct and resubmit the claim under an eligible provider instead.
What documentation helps most with a CARC 170 appeal?
Credentialing records, taxonomy/NPI verification, and documentation of any supervising-provider or incident-to arrangement that supports the provider's eligibility to bill the service.
Can this template guarantee the appeal will be approved?
No. This is only a template to help organize an appeal; outcomes depend on payer policy and the specific facts of the claim, and no result can be 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 generic fill-in-the-blank starting point; review your payer's specific policies before submission. Use of this template does not guarantee that an appeal will be successful or that a denial will be overturned.
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