260Denial Code (CARC)Active
CO 260 Denial Code - Medicaid ACA Fee Adjustment
Code 260 indicates that the claim has been processed under the Medicaid ACA Enhanced Fee Schedule. This means the payment has been adjusted according to special reimbursement rates established by the Affordable Care Act for Medicaid services.
Who Pays: Group Code Liability
For code 260, the adjustment typically falls under the CO group code, meaning it's a contractual write-off and the patient cannot be billed for the difference.
Why Claims Get Code 260
- The claim was submitted for a Medicaid-covered service eligible for ACA-enhanced rates.
- The service was performed by a provider enrolled in Medicaid's ACA Enhanced Fee program.
- The payer automatically applied the ACA Enhanced Fee Schedule to the claim.
- The billing system recognized the service code as eligible for enhanced Medicaid reimbursement.
How to Fix & Resubmit
- Verify that the service is eligible for Medicaid ACA Enhanced Fee Schedule rates.
- Check the payer's reimbursement policy for ACA-enhanced services to ensure correct processing.
- Confirm that the provider is enrolled in the Medicaid ACA Enhanced Fee program.
- Ensure the billed amount matches the expected enhanced fee schedule rate.
- If discrepancies exist, contact the payer for clarification on the applied rates.
Corrected Claim or Appeal?
For code 260, no appeal or corrected claim is typically necessary if the adjustment aligns with Medicaid's ACA Enhanced Fee Schedule. If the payment seems incorrect, contact the payer for clarification rather than filing an appeal.
Preventing Future 260 Denials
- Ensure all Medicaid claims are reviewed for ACA Enhanced Fee eligibility before submission.
- Keep current with Medicaid ACA Enhanced Fee Schedule updates and changes.
- Regularly verify provider enrollment in the Medicaid ACA Enhanced Fee program.
- Maintain accurate records of expected reimbursement rates for ACA-enhanced services.