287Denial Code (CARC)Active
CO 287 Denial Code: Referral Exceeded Solutions
Code 287 means that the service rendered exceeded the number of visits or services authorized in the patient's referral. The payer has denied reimbursement for the services that went beyond what was originally approved.
Who Pays: Group Code Liability
Typically, CO applies to code 287, meaning the provider writes off the amount as it is a contractual obligation. However, if the plan allows, PR may apply, making the excess visits billable to the patient.
Why Claims Get Code 287
- The patient received more services than the referral authorized.
- The referral was not updated or extended for additional services.
- The billing office submitted claims without checking the referral limits.
- Referral information was not properly communicated to the scheduling department.
How to Fix & Resubmit
- Verify the number of services authorized in the original referral.
- Check if an updated or extended referral was obtained before the additional services were rendered.
- Contact the referring provider to issue a new referral if needed.
- Submit a corrected claim if a valid referral covers the services, or appeal with documentation if appropriate.
- Adjust the account for a contractual write-off if no further action is possible.
Corrected Claim or Appeal?
Submit a corrected claim if a valid referral covers the additional services. If you have documentation supporting the need for more visits, consider a formal appeal. Otherwise, adjust as a contractual obligation.
Preventing Future 287 Denials
- Ensure referrals are reviewed for service limits before scheduling.
- Implement a system for tracking referral expirations and limits.
- Communicate referral details clearly to all relevant staff.
- Regularly train staff on referral management and authorization requirements.