Charge is above the contracted rate. The difference is written off.
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.
Not a denial. A contracted write-down or patient responsibility. Not money you lost.
In the order we see it.
The charge exceeds the contracted rate. This is the write-down you agreed to.
Contractual adjustment. Only worth review if the fee schedule loaded wrong.
The documentation, not the argument.
Your contracted fee schedule, if the allowed amount looks wrong for the code.
The common mistake. Do not appeal a correct contractual adjustment. Do check that the fee schedule loaded correctly, because a bad load shows up here first.
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