DENIAL/DECODER

For clinic billing teams and RCM staff · Local-first · No claim data uploaded · No account required

给诊所计费与 RCM 团队 · 全本地运行 · 不上传理赔数据 · 无需注册

Paste the remittance codes. Get the next action before the window closes.贴进付款通知上的代码，在时限关上之前拿到下一步动作。

Paste the codes off the remittance. Get what each one means, whether it is appealable or just a rebill, which document usually gets it paid, and how many days are left. You enter the payer’s appeal window from your contract — we only count the days. We never invent a deadline.把付款通知上的代码贴进来。每个代码是什么意思、属于可申诉还是更正重报、通常靠哪一份材料把钱要回来、还剩几天。时限由你按合同填，我们只负责倒数，绝不替你编一个截止日。

CO-16
CO-197
PR-2
→
Missing information — read the RARC 缺少信息 —— 去看随附的 RARC No prior authorization — appealable 缺预授权 —— 可申诉 Coinsurance — bill the patient, not a denial 共保额 —— 向患者收取，这不是拒赔

Runs in your browser. No claim data is uploaded. No patient name, date of birth or member id is ever requested.全部在你的浏览器里运行，不上传任何理赔数据；从不索取患者姓名、出生日期或会员号。

Free local decoder · no account required本地解码器，免费 · 无需注册

Paste CARC/RARC codes only. Do not paste patient names, member IDs, dates of birth or claim PDFs. Codes are decoded in this browser tab.只贴 CARC/RARC 代码。不要贴患者姓名、会员号、出生日期或理赔 PDF。代码在这个浏览器标签页里解析。

Any format: CO-16, co16, PR 2, B7. Separators do not matter. 格式随意：CO-16、co16、PR 2、B7 都认，分隔符无所谓。 Decode a sample remittance载入示例
From your contract or the payer's manual. This tool does not guess it.来自你的合同或该付款方的手册。本工具不替你猜。
01 · The gap

Why so much money sits in denials为什么这么多钱卡在拒赔里

19.1%of in-network Marketplace claims were denied — about 8.8 million of 46 million (CMS Transparency in Coverage 2026 file, plan year 2024)网内 Marketplace 理赔被拒的比例——4600 万条中约 880 万条（CMS Transparency in Coverage 2026 文件，2024 计划年度）
77%of those denials came down to paperwork errors and plan design, not the care itself (same CMS Transparency in Coverage 2026 file, plan year 2024)这些拒赔中属于文书错误与计划设计问题的比例，不是医疗本身（同一份 CMS Transparency in Coverage 2026 文件，2024 计划年度）
<1%of denied Marketplace claims were appealed at all被拒的 Marketplace 理赔中真正提出申诉的比例
50–70 minis what clinic billing teams commonly report spending on one appeal letter. This page does not write the letter — it builds the triage sheet so you stop starting from a blank page.诊所计费团队普遍反映的：起草一封申诉信要花的时间。这一页不替你写信，它给你那张分诊表，让你不必从空白页开始。

Sources: 来源： CMS TiC 2026 PUF analysis · appeal drafting time · CMS appeal outcomes

02 · Boundaries

Operated by TJ NOVA LTD, registered in England and Wales, company number 17308318. This page uses a hand-checked subset of the X12 CARC list; it does not receive, store or transmit claim files or PHI.运营方 TJ NOVA LTD，于英格兰及威尔士注册，公司编号 17308318。本页使用逐条核对过的 X12 CARC 子集；不接收、不存储、不传输任何理赔文件或受保护健康信息。

What this does not do这东西做不到什么

  • It does not predict whether you will win. CMS reports roughly 80.7% of appealed Medicare Advantage denials are partly or fully overturned; Marketplace insurers upheld 66% of the appeals they received. Two official figures pointing opposite ways — both are printed here as they are, with no weighting.不预测你能不能赢。CMS 口径下 Medicare Advantage 申诉约 80.7% 被部分或全部推翻；而 Marketplace 侧保险公司维持了收到申诉的 66%。两个官方数字方向相反——这里原样列出，不加权。
  • It does not guess a code it does not hold. Unknown codes are reported as not in this list. X12 revises the CARC/RARC lists three times a year.不猜没收录的代码。未收录就显示未收录。X12 每年修订 CARC/RARC 清单三次。
  • It does not submit anything and it does not touch PHI. It never asks for a patient name, date of birth or member id.不替你提交任何东西，也不接触受保护健康信息。从不索取患者姓名、出生日期或会员号。
  • It is not medical or legal advice. It is an administrative billing aid.不是医疗或法律意见，只是一个行政计费辅助工具。
03 · Questions

Questions people actually ask真实会被问到的问题

Does my claim data leave the browser?我的理赔数据会离开浏览器吗？

No. Everything runs on your device, and the tool only ever asks for codes, a date and a number.不会。全部在你的设备上运行，而且只问代码、日期和一个天数。

Which code list is this?这是哪一版代码清单？

A hand-checked subset of the most common CARC values, not the full X12 set. Anything outside it says so.是逐条核对过的高频 CARC 子集，不是 X12 全集。不在其中的会明确标出。

Why does it refuse to score my chances?为什么不肯给我算胜率？

Because the two official numbers disagree, and a made-up score would be the most expensive thing on this page.因为两个官方数字本身就打架，而编一个分数会是这一页上最贵的东西。

Who runs this?这是谁在运营？

TJ NOVA LTD, registered in England and Wales, company number 17308318.TJ NOVA LTD，于英格兰及威尔士注册，公司编号 17308318。