CARC · CO group
CO-242
Services not provided by a network or primary care provider
Contractual obligation; provider write-off unless appealed
- What it means
- The payer processed the claim as out-of-network.
- Likely cause
- Clinician not yet loaded to the group contract, or a roster/effective-date gap after a new hire.
- How to fix it
- Confirm the effective date on the payer roster and appeal for retro in-network processing back to the credentialing effective date.
- Revenue impact
- Often recoverable for months of claims at once. This is a classic audit finding.
- credentialing
- network status
- roster
Related codes
Early access
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