CARC 142: Monthly Medicaid Patient Liability Amount

What it means

This code shows that a portion of the claim isn't being paid because the patient has a monthly Medicaid patient liability (sometimes called a 'spend-down' or 'share of cost') that applies to this service. Medicaid is reducing its payment by the amount the patient is responsible for paying each month before Medicaid coverage kicks in.

Common causes

Patient is enrolled in a Medicaid spend-down or share-of-cost program
Patient's monthly liability amount has not yet been met for the billing period
Claim was submitted without accounting for the patient's known liability amount
Patient liability amount changed and the claim reflects outdated information
Coordination of benefits or eligibility verification wasn't completed before billing

How to fix it

Verify the patient's current Medicaid eligibility and monthly liability amount through the state Medicaid portal or eligibility system
Confirm whether the patient's spend-down has been met for the applicable month
Bill the patient directly for the liability amount if it has been verified and is their responsibility
Check if other providers' charges have already been applied toward the patient's spend-down for that month
Resubmit the claim with correct liability information if a data entry error caused the incorrect amount
Contact the state Medicaid agency if there's a discrepancy in the reported liability amount

Appeal / resubmit

If you believe the patient liability amount applied is incorrect, gather documentation showing the patient's actual spend-down status for that month, including any other provider claims already applied. Contact the state Medicaid agency's eligibility unit to verify the correct liability amount before filing a formal appeal. Include eligibility verification printouts and a clear explanation of the discrepancy in your appeal.

Related codes

Frequently asked

Does this mean the claim was denied?

Not necessarily a full denial—it typically means Medicaid reduced its payment by the patient's liability amount, and that portion may need to be collected from the patient or applied toward their spend-down.

Can I bill the patient for this amount?

Often yes, since this represents the patient's own financial responsibility under their Medicaid plan, but you should verify the exact amount and confirm it hasn't already been satisfied by other providers before billing.

How do I find out the patient's liability amount?

Check the state Medicaid eligibility verification system or contact the state Medicaid agency directly, as this information is typically available through provider portals.

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

This content is informational only and does not constitute billing or legal advice. Always verify with current payer policy and applicable regulations.