Something the payer needed was missing or wrong on the claim.
CO — Contractual obligation — the provider absorbs it and cannot bill the patient.
So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
Fix and resubmit. This is a correction, not an appeal. Appealing burns the deadline.
In the order we see it.
The RARC printed beside this code names the actual missing item.
A missing or invalid NPI, referring provider, modifier or accident date.
Read the RARC beside it; that names the missing item. Correct and resubmit.
The documentation, not the argument.
A corrected claim with the missing element supplied.
The common mistake. Do not appeal this. It is a correction, and an appeal spends the timely-filing clock on a claim that would have paid on resubmission.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
Send your denial summary for the last ninety days. Four columns: payer, CARC code, count, billed amount. I will tell you which were winnable and what they were worth.
Send your denial summary No patient data. No BAA. No charge.
AppealHound