CARC code 242 — Services not provided by network/primary care providers

What CARC 242 means

Out-of-network denials mean the provider was outside your plan's network.

How to appeal a CARC 242 denial

Appeals usually focus on whether No Surprises Act protections apply (for emergencies and certain ancillary services), whether in-network alternatives were unavailable, or whether continuity-of-care rules apply.

What InsureDefense adds

Our triage classifies your specific denial into one of ten categories and tells you exactly what evidence appeals like yours typically need. For CARC 242 denials, we usually recommend the tier that fits the category of the denial — sometimes Strong ($249) is enough, sometimes Premium ($499) with plan-language citations and peer-reviewed support is the right path. The free triage shows you which.

Upload your denial Read the full appeal guide