147Denial Code (CARC)Active
CO 147 Denial Code - Contract Rate Expired Solution
Code 147 indicates that the claim was adjusted because the provider's contracted or negotiated rate with the payer either expired or wasn't on file. This means the payer didn't apply the expected contracted rate, which can result in the claim being underpaid or denied.
Who Pays: Group Code Liability
The group code for code 147 is typically CO, meaning the provider must write off the difference. The patient cannot be billed for this amount, as it's a contractual issue between the provider and the payer.
Why Claims Get Code 147
- The provider's contract with the payer has expired and wasn't renewed.
- The contracted rates were not updated in the payer's system.
- The provider's contract is not on file with the payer for the billed date of service.
- Rates were incorrectly entered during contract setup or renewal.
- The claim was processed before the new contract terms were applied.
How to Fix & Resubmit
- Verify the current contract status with the payer to ensure it's active and correctly on file.
- Check if the contracted rates are up-to-date in both your system and the payer's system.
- Contact the payer to confirm whether the contracted rates were applied correctly to the claim.
- If the contract was renewed, submit any necessary documentation to the payer to update their records.
- Once the contract issue is resolved, resubmit the claim to the payer for reprocessing.
Corrected Claim or Appeal?
For code 147, usually a corrected claim is warranted after ensuring the contract is active and on file. If the payer's records are incorrect, you may need to formally appeal with supporting documentation from the contract.
Preventing Future 147 Denials
- Regularly verify that all contracts are current and on file with each payer.
- Ensure timely updates and renewals of contracts to avoid expiration issues.
- Maintain clear communication with payers regarding any contractual changes.
- Periodically audit payer records to ensure they align with your contract terms.