284Denial Code (CARC)Active
CO 284 Denial Code - Fix Precertification Issues
Code 284 indicates that while the precertification, authorization, or notification number provided is valid, it does not pertain to the services billed on the claim. This suggests a mismatch between the service authorized and what was actually rendered and billed.
Who Pays: Group Code Liability
With code 284, the group code is typically CO, meaning the provider must write off the amount as it is not billable to the patient. However, if contract terms allow, some payers might apply PR, making the patient responsible.
Why Claims Get Code 284
- The authorization number entered on the claim was intended for a different service than what was billed.
- The billed service was performed without obtaining the correct authorization.
- Clerical error in entering the authorization number on the claim.
- Authorization expired before the service was provided.
- Authorization was obtained for a different provider or facility.
How to Fix & Resubmit
- Verify the authorization details against the service billed to ensure it matches.
- Contact the payer to confirm the correct authorization requirements for the billed service.
- Obtain a retroactive authorization if the payer allows and the service qualifies.
- Correct the authorization number on the claim if a clerical error occurred.
- Submit a corrected claim with the correct authorization details if applicable.
Corrected Claim or Appeal?
Submit a corrected claim if the authorization number was entered incorrectly. If the service wasn't authorized correctly, appeal with evidence of any retroactive authorization granted.
Preventing Future 284 Denials
- Ensure that the authorization obtained is specific to the service being rendered.
- Cross-check authorization numbers with the billed services before claim submission.
- Implement a checklist for verifying authorization details during the patient registration process.
- Train staff on payer-specific authorization requirements to minimize errors.