CARC · CO group

CO-45

Charge exceeds fee schedule or maximum allowable amount

Contractual obligation; provider write-off unless appealed

What it means

The contractual write-down between your billed charge and the contracted allowed amount.

Likely cause

Normal on in-network claims. It is only a problem when the allowed amount is lower than your contracted rate.

How to fix it

Reconcile the allowed amount on every 835 line against your loaded fee schedule. Dispute any line allowed below contract.

Revenue impact

Silent underpayment. CO-45 is not a denial, which is exactly why nobody audits it.

• underpayment
• fee schedule
• contractual