The procedure does not fit the patient's age.
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.
A wrong date of birth on the claim.
A code carrying an age restriction billed outside that range.
Check the date of birth on the claim against the age range on the code, then correct whichever is wrong.
The documentation, not the argument.
The corrected date of birth, or a code appropriate to the patient's age.
The common mistake. Do not appeal before you check the date of birth. It is usually a typo, and a correction pays faster than an argument.
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