118Denial Code (CARC)Active
CO 118 Denial Code - ESRD Network Adjustment Explained
Code 118 refers to an adjustment made to support the End-Stage Renal Disease (ESRD) network. This adjustment reflects a reduction in payment to account for contributions to the ESRD network, which is a mandatory part of certain payer agreements.
Who Pays: Group Code Liability
For code 118, the adjustment typically falls under the CO (Contractual Obligation) group code, meaning the provider must write off this amount and cannot bill the patient.
Why Claims Get Code 118
- The payer has applied a standard ESRD network support fee.
- The provider is part of a contract that includes ESRD network contributions.
- The claim involves services related to dialysis or ESRD treatment.
- Contractual agreements with the payer include ESRD network support.
- The payer applies this adjustment automatically for ESRD-related claims.
How to Fix & Resubmit
- Verify that the claim involves ESRD-related services, as this is necessary for code 118 to apply.
- Check the payer contract to confirm that ESRD network support adjustments are stipulated.
- If the adjustment is unexpected, contact the payer for clarification on the ESRD network fee application.
- Ensure that the adjustment aligns with the contractual terms agreed upon with the payer.
- Document the adjustment as a contractual write-off in your billing system.
Corrected Claim or Appeal?
A formal appeal is generally not applicable for code 118, as this is a contractual adjustment. However, if you believe the adjustment was applied in error, review the payer contract and contact the payer for clarification.
Preventing Future 118 Denials
- Review payer contracts to understand ESRD network support terms before claim submission.
- Educate billing staff on ESRD-related adjustments to prevent confusion.
- Ensure claims for dialysis or ESRD services are flagged for potential adjustments.
- Maintain updated records of contractual obligations with payers.