102Denial Code (CARC)Active
CO 102 Denial Code - Major Medical Adjustment Fix
Code 102 indicates that the payment was adjusted due to terms specific to a major medical policy. This typically means the payer has applied a reduction based on the patient's major medical coverage details.
Who Pays: Group Code Liability
For code 102, the adjustment usually falls under the CO group code, meaning it's a contractual write-off and the patient should not be billed. However, if the payer specifies PR, then the patient may be responsible for the adjusted amount.
Why Claims Get Code 102
- The patient's major medical policy terms dictate a specific adjustment.
- The service was covered under a major medical plan with a different allowable amount.
- The payer applied a reduction based on the patient's major medical deductible.
- Coordination of benefits indicated that a major medical policy was primary and required adjustment.
How to Fix & Resubmit
- Verify the patient's major medical plan terms to understand the adjustment.
- Check if the major medical deductible has been applied correctly.
- Review coordination of benefits to confirm the correct primary payer.
- Contact the payer for a detailed explanation if the adjustment seems incorrect.
- Adjust your system records to reflect the contractual write-off, unless PR applies.
Corrected Claim or Appeal?
Submit a corrected claim only if the payer's adjustment doesn't align with the major medical policy terms. If the payer confirms the adjustment is per policy, an appeal is unlikely to succeed.
Preventing Future 102 Denials
- Ensure accurate entry of the patient's major medical policy details at registration.
- Verify coordination of benefits before claim submission to identify primary coverage.
- Regularly update your records with the latest major medical policy changes.
- Train staff to recognize and apply major medical policy terms during billing.