76Denial Code (CARC)Active
CO 76 Denial Code - Disproportionate Share Adjustment
Code 76, labeled as "Disproportionate Share Adjustment," appears on a remittance advice when the payer adjusts the claim based on a disproportionate share hospital (DSH) payment adjustment. This adjustment reflects additional funds provided to certain hospitals that serve a large number of low-income patients.
Who Pays: Group Code Liability
For code 76, the group code is typically CO, indicating a contractual adjustment where the provider writes off the amount and the patient cannot be billed for this adjustment.
Why Claims Get Code 76
- The provider is a designated disproportionate share hospital and receives specific adjustments for serving low-income patients.
- The payer applied a DSH adjustment according to the hospital's qualification status.
- The claim was processed under a payment methodology that includes DSH adjustments.
- The provider's contract with the payer includes terms for DSH adjustments.
How to Fix & Resubmit
- Verify that the hospital is indeed qualified as a disproportionate share hospital.
- Check the contract terms with the payer to confirm the DSH adjustment is correctly applied.
- Review the claim to ensure all necessary data supporting DSH qualification was submitted.
- Contact the payer for clarification if the adjustment seems inconsistent with contractual terms.
- Document the adjustment as a contractual write-off in the billing system.
Corrected Claim or Appeal?
For code 76, appeals are generally not appropriate as this is a standard contractual adjustment. Corrections may be needed if the hospital's DSH status was incorrectly reported.
Preventing Future 76 Denials
- Ensure the hospital's DSH status is accurately documented and communicated to payers.
- Regularly review payer contracts to understand DSH adjustment terms.
- Train staff on identifying and processing DSH-related adjustments correctly.
- Maintain updated records of DSH qualification to support claims processing.