274Denial Code (CARC)Active
CO 274 Denial Code: Care Coordination Fee Issue
Code 274 indicates that the service or fee submitted is not covered based on the patient's Care Coordination arrangement. This denial means the service was deemed non-payable under the terms of a care management plan the patient is enrolled in.
Who Pays: Group Code Liability
Typically, the group code CO applies, meaning the provider must write off the charge and cannot bill the patient. However, if the patient's plan specifies otherwise, it could be PR, making it patient responsibility. Verify with the payer.
Why Claims Get Code 274
- Service not included in the patient's Care Coordination plan.
- Care Coordination arrangement not updated in the patient's file.
- Incorrect coding of services that are part of a care plan.
- Submission of a claim for a non-covered service under the care plan.
How to Fix & Resubmit
- Verify the patient's Care Coordination plan details with the payer.
- Check if the service provided is included under the patient's care plan.
- If the service is covered, correct the coding and resubmit the claim.
- If the service is not covered, consider writing off the charge as per payer's policy.
- Contact the payer for clarification if the denial reason is unclear.
Corrected Claim or Appeal?
Submit a corrected claim if the service was incorrectly coded or if the Care Coordination arrangement was not properly applied. If the service is genuinely non-covered, no appeal is needed.
Preventing Future 274 Denials
- Ensure accurate recording of the patient's Care Coordination plan details in the system.
- Verify service coverage under the Care Coordination plan before rendering service.
- Regularly update care plan information as provided by the payer.
- Train staff on understanding Care Coordination arrangements specific to your patient population.