174Denial Code (CARC)Active
CO 174 Denial Code - Fix Missing Prescription Issues
Code 174 means that the payer determined the service was performed without a required prior prescription. This denial indicates that the payer expected the service to be authorized or prescribed before it was rendered.
Who Pays: Group Code Liability
For code 174, the group code is typically CO, meaning the provider must write off the amount and cannot bill the patient. However, if the payer's policy allows, it could be PR, making it patient responsibility if the patient failed to obtain a necessary prescription.
Why Claims Get Code 174
- The service was performed without obtaining a required prescription from a referring provider.
- The prescription was obtained after the service was rendered, violating payer requirements.
- Documentation of the prescription is missing from the claim submission.
- The prescription was for a different service than what was performed.
- The payer's policy was not checked prior to service delivery, leading to non-compliance.
How to Fix & Resubmit
- Verify whether the service truly required a prior prescription according to the payer's policy.
- Check if the prescription was obtained and documented correctly before the service was provided.
- If a valid prescription exists, gather supporting documentation and submit a corrected claim.
- If the prescription was not obtained, contact the referring provider to see if retroactive documentation can be secured and appeal if possible.
- Ensure all documentation matches the service billed before resubmitting.
Corrected Claim or Appeal?
Submit a corrected claim if documentation can be provided showing a prior prescription. If no prescription was obtained, an appeal may be attempted with retroactive documentation, but success depends on payer policy.
Preventing Future 174 Denials
- Always verify prescription requirements with the payer before providing services.
- Ensure prescriptions are documented and retained in patient records prior to service delivery.
- Train staff on the importance of checking payer policies for prior authorization requirements.
- Implement a checklist for verifying necessary documentation before claim submission.