307Denial Code (CARC)Active
CO 307 Denial Code - Medicare Price Adjustment Guide
Code 307 indicates that an adjustment was made due to the Medicare Maximum Fair Price Standard Default Refund Amount. This adjustment is specifically related to the Medicare Drug Price Negotiation Program, and the accompanying remark code will provide further details on why this adjustment was necessary.
Who Pays: Group Code Liability
For code 307, the adjustment is typically categorized under the CO group code, meaning it's a contractual obligation and the patient should not be billed for this amount.
Why Claims Get Code 307
- The claim involved a drug covered under the Medicare Drug Price Negotiation Program.
- The Medicare Maximum Fair Price was applied, resulting in an adjustment.
- The payer identified a pricing discrepancy based on the negotiated drug price.
- An incorrect drug price was initially billed, prompting the adjustment.
How to Fix & Resubmit
- Review the accompanying remark code for specific details about the adjustment.
- Verify that the drug price billed aligns with the Medicare Maximum Fair Price standards.
- If an error in pricing or billing is identified, correct the claim details.
- Submit a corrected claim if the original billing did not adhere to the negotiated price.
- Contact the payer for clarification if the reason for the adjustment is unclear after reviewing the remark code.
Corrected Claim or Appeal?
For code 307, if the adjustment was due to a legitimate application of the Medicare Maximum Fair Price, no appeal or correction is needed. If you identify a billing error that contradicts this standard, submit a corrected claim.
Preventing Future 307 Denials
- Ensure all drug prices billed align with the Medicare Drug Price Negotiation Program standards.
- Regularly update billing systems with the latest Medicare Maximum Fair Prices.
- Train billing staff on the specifics of the Medicare Drug Price Negotiation Program.
- Audit claims for compliance with negotiated drug pricing before submission.