Filed after the payer deadline.
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.
Usually lost. Recoverable only with unusual evidence. Triage by dollar value.
In the order we see it.
The claim was filed after the payer's deadline.
The primary paid late and the secondary clock ran out.
The claim rejected at the clearinghouse and was never resubmitted.
Only recoverable with proof of timely submission: a clearinghouse acceptance report, or evidence the primary paid late.
The documentation, not the argument.
A clearinghouse acceptance report carrying the original submission date.
The primary payer's EOB date, where the delay was theirs.
The common mistake. Do not appeal without a timestamp. Without proof of timely submission there is nothing to argue, and the appeal is wasted effort.
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