CARC 288 appeal letter template — Referral Absent
CARC 288 indicates the claim was denied because the required referral was not on file or not submitted with the claim; this template helps providers appeal when a valid referral did in fact exist at the time of service.
When to appeal vs. correct & resubmit
Appeal using this template if a valid referral was obtained prior to or on the date of service but was not properly transmitted, recorded, or matched to the claim (e.g., payer system error, clearinghouse issue, or documentation on file that was overlooked). If no referral was actually obtained before the service was rendered, correct the claim by securing a retroactive referral if the payer allows one, or resubmit only after proper referral documentation is in place rather than filing a formal appeal.
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 288 (Referral Absent) Patient Name: [Patient Name] Member ID: [Member ID] Claim Number: [Claim #] Date(s) of Service: [DOS] Billed Provider: [Provider Name, NPI] Procedure/Service Code(s): [CPT/HCPCS] Referring Provider: [Referring Provider Name, NPI] Referral/Authorization #: [Authorization #] Dear Appeals Review Team, We are writing to formally appeal the denial of the above-referenced claim, which was denied under CARC 288, indicating that a referral was absent. We respectfully disagree with this determination and submit the following supporting information for reconsideration. A referral for the service(s) billed under [CPT/HCPCS] was obtained from [Referring Provider Name, NPI] prior to the date of service, [DOS]. Documentation evidencing this referral, including the referral number [Authorization #], is enclosed for your review. We believe this referral satisfies the requirement referenced in the denial and that the claim was denied in error, potentially due to a data transmission, matching, or system issue on the payer's end. We ask that [Payer Name] review the enclosed referral documentation alongside the original claim submission and reprocess claim [Claim #] for payment accordingly. Please let us know if any additional information is needed to complete this review. Enclosed please find: - Copy of the Explanation of Benefits/Electronic Remittance Advice (EOB/ERA) reflecting the CARC 288 denial - Referral documentation/authorization form - Relevant medical records supporting the referral and services rendered Thank you for your attention to this matter. Please direct any questions or requests for additional documentation to [Provider Name, NPI] at [Phone] or [Email]. Sincerely, [Provider Name, NPI] [Practice Name] [Phone] [Email]
What to attach
- EOB/ERA showing the CARC 288 denial
- Copy of the referral or referral authorization form
- Referring provider's order or note documenting the referral
- Relevant medical records supporting medical necessity of the referred service
- Any payer correspondence or portal confirmation showing the referral was submitted/approved
Frequently asked questions
What does CARC 288 mean?
CARC 288 means the payer's records show no valid referral on file for the billed service, which is a condition of coverage under the patient's plan.
Should I appeal or resubmit the claim?
If a referral existed before the date of service but wasn't properly recorded or matched by the payer, an appeal with supporting documentation is appropriate. If no referral was obtained, check whether a retroactive referral is possible, or correct the claim before resubmitting.
What documentation best supports this appeal?
Include a copy of the referral or authorization, the referring provider's order, and any system/portal confirmation showing the referral was active at the time of service.
Can I use this template for every payer?
This is a general template; always review the specific payer's appeal submission requirements, deadlines, and format before sending.
More free billing tools: all appeal letters · denial codes · NCCI edits · Medicare fees
This template is provided for informational purposes only and does not constitute legal, billing, or coding advice. It is a general starting point and must be customized to the specific payer, plan, and claim circumstances. Submitting an appeal does not guarantee reversal of the denial or payment of the claim.
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