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CARC 109Not covered by this payer or contractorSubmit to correct payer

CARC 109: Claim Sent to the Wrong Payer or Contractor

The receiving payer or contractor is not responsible for the claim under the member, plan, jurisdiction, contract, or service facts.

First checks

  1. 1Confirm exact plan and payer ID for the date of service.
  2. 2Verify provider contract and service jurisdiction.
  3. 3Check Medicare Advantage versus Original Medicare and DME MAC routing.

Resolution path

  1. 01Identify the responsible payer or contractor.
  2. 02Correct enrollment or routing data when needed.
  3. 03Submit promptly to the correct destination with prior processing proof if relevant.
  4. 04Protect the new payer's timely-filing deadline.

Evidence packet

  • Insurance card and eligibility response
  • Payer routing table
  • Contract or jurisdiction source
  • Prior denial notice

Prevent the next denial

Validate plan, network, product, payer ID, contractor jurisdiction, and date-specific routing before submission.

Official sources

CMS Health Care Payment and Remittance AdviceReviewed 2026-07-10Medicare Claims Processing ManualReviewed 2026-07-10

Use the current payer notice, contract, code set, policy, and filing instructions. This guide is educational and does not determine patient liability or appeal rights for an individual claim.