CARC 27 appeal letter template — Expenses Incurred After Coverage Terminated
CARC 27 indicates the payer determined the service date falls after the patient's coverage ended; this template disputes that determination when eligibility records conflict with the payer's termination date.
When to appeal vs. correct & resubmit
Appeal if you have evidence the patient's coverage was active on the date of service (e.g., eligibility verification printout, premium payment records, COBRA continuation, or a retroactive reinstatement) that contradicts the payer's termination date. If the coverage was in fact terminated prior to the date of service and no such evidence exists, correct the claim by billing the correct payer, the patient, or writing off the balance per policy 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 Denial — CARC 27 (Expenses Incurred After Coverage Terminated) Patient Name: [Patient Name] Member ID: [Member ID] Claim #: [Claim #] Date(s) of Service: [DOS] Provider: [Provider Name, NPI] CPT/HCPCS: [CPT/HCPCS] Dear Appeals Review Team, This letter appeals the denial of the above claim under CARC 27, described as "Expenses incurred after coverage terminated." Our records indicate the patient's coverage was active on the date(s) of service listed above, which conflicts with the termination date used to deny this claim. Enclosed is documentation supporting active coverage on [DOS], including [eligibility verification / enrollment confirmation / premium payment record / COBRA or retroactive reinstatement notice]. We respectfully request that the claim be reprocessed based on this evidence. If the termination date on file differs from what is reflected in your eligibility system, we ask that your office confirm the correct effective and termination dates for this member and advise whether reprocessing can occur administratively or requires this formal appeal to proceed. Please reprocess this claim or provide a written explanation if the denial is upheld, along with any additional documentation needed to complete your review. Thank you for your attention to this matter. Please contact us at [Phone] or [Email] with any questions or for additional records. Sincerely, [Provider Name, NPI] [Practice Name] [Phone] [Email]
What to attach
- Copy of the EOB/ERA showing CARC 27 denial
- Eligibility verification record for the date of service
- Proof of active coverage (enrollment confirmation, premium payment history, or ID card effective dates)
- COBRA election or retroactive reinstatement documentation, if applicable
- Prior authorization or referral records, if relevant to the claim
Frequently asked questions
What does CARC 27 mean?
It means the payer's records show the patient's coverage had ended before the date of service billed, so the claim was denied as not covered.
When should I appeal instead of rebilling?
Appeal when you have documentation showing coverage was actually active on the date of service. If coverage truly ended, rebill the correct payer or the patient instead.
What if the patient had a new plan after termination?
If a new payer took over coverage on that date, submit the claim to the new payer rather than appealing this denial.
Can this letter guarantee the claim will be paid?
No. This template helps structure an appeal, 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 generic starting point to be customized with accurate, verified information for each claim. Appeal outcomes are not guaranteed, and payers may uphold the original denial regardless of documentation submitted.
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