CARC 111: Not Covered Unless the Provider Accepts Assignment

What it means

The payer is denying or reducing payment because this service is only covered when the billing provider has agreed to accept assignment of benefits. If the provider did not accept assignment on this claim, the payer will not pay for the service under this plan's rules.

Common causes

The provider is non-participating and did not check or elect the 'accept assignment' box on the claim
The payer's plan (often a government or government-sponsored plan) requires assignment for this specific benefit or service type
A claim was submitted as unassigned when the provider's contract or enrollment status actually requires assignment for that service
Incorrect provider enrollment or participation status on file with the payer
Assignment indicator was entered incorrectly in the billing software or claim form (e.g., Box 27 on CMS-1500)

How to fix it

Confirm the provider's participation/assignment status with the payer for this specific plan and service
Verify that the 'accept assignment' field (e.g., CMS-1500 Box 27) was completed correctly on the original claim
If assignment should have been accepted, correct and resubmit the claim indicating acceptance of assignment
Check payer-specific policy to confirm whether this service category always requires assignment
If the provider does not accept assignment, review whether the patient can be billed directly and whether that aligns with plan rules and provider agreements
Contact the payer's provider services line to clarify why assignment status was flagged as an issue

Appeal / resubmit

If the provider does in fact accept assignment for this service, submit a corrected claim or appeal with documentation showing the provider's assignment agreement or participation status, and reference the original claim number. Include any signed assignment of benefits form if applicable. Appeals are more likely to be considered when there is clear evidence the assignment indicator was incorrect on the original submission rather than a true policy restriction.

Related codes

96
N95
N130

Frequently asked

What does 'accepting assignment' mean?

It means the provider agrees to accept the payer's approved amount as full payment for the service, rather than billing the patient directly for the full charge.

Can this denial be fixed by resubmitting the claim?

Yes, if the assignment indicator was entered incorrectly and the provider does accept assignment, correcting and resubmitting the claim may resolve the denial.

Does this mean the patient can be billed for the full amount?

It depends on the plan's rules and the provider's agreements; billing staff should check payer policy and provider contracts before billing the patient.

More free billing tools: all denial codes · denial lookup · Medicare fee calculator

This content is for informational purposes only and does not constitute billing or legal advice. Always verify specific requirements with the payer.