Denial Management Guide

Understanding Claim Adjustment Reason Codes (CARC) and how to resolve them effectively.

CARC Code	Reason for Denial	Category	Our Solution
CO-50	Non-covered service	Authorization & Eligibility	Payer-specific CPT mapping / Modifier correction
CO-197	Authorization required	Authorization & Eligibility	Verify auth before first visit
CO-96	Service not consistent with diagnosis	Authorization & Eligibility	Diagnosis-to-procedure cross-check
CO-119	Benefit maximum reached	Authorization & Eligibility	Track authorized vs used units in real time
CO-151	Incomplete documentation	Documentation & Coding	Pre-submission documentation audit
CO-22	Coordination of benefits issue	Documentation & Coding	Eligibility verification before visit
CO-18	Duplicate claim	Documentation & Coding	Claim history check before resubmission
CO-4	Incorrect modifier	Documentation & Coding	Specialty-specific modifier rules
CO-97	Bundled service	Timed Units & Frequency	Proper use of modifier-59
CO-55	Frequency exceeded	Timed Units & Frequency	Visit counter per payer plan
CO-125	Submission outside timely filing	Timed Units & Frequency	Daily claim aging dashboard

Did you know that 90% of denials are preventable? We identify patterns in your denials to address root causes at the source.

Our team achieves an average denial rate below 3%. We aggressively follow up on every denial within 24 hours of notification.