94Denial Code (CARC)Active
CO 94 Denial Code - Resolve Excess Charge Issues
Code 94 indicates that the claim was processed for an amount exceeding the charges submitted. This usually happens when the payer's system miscalculates or when duplicate claims are inadvertently processed.
Who Pays: Group Code Liability
Typically, CO group code applies, meaning the excess amount is a contractual write-off and cannot be billed to the patient. If PR is used, verify with the payer before billing the patient.
Why Claims Get Code 94
- Duplicate submission of the same claim by mistake.
- Payer system miscalculation leading to overpayment.
- Incorrect charge amount entered on the claim.
- System error during claim processing.
How to Fix & Resubmit
- Verify the charges submitted on the original claim against the remittance advice.
- Check for any duplicate claims submitted for the same service date.
- Contact the payer to confirm if an error occurred on their end.
- If a system error is confirmed, request an adjustment from the payer.
- Submit a corrected claim if your initial charge submission was incorrect.
Corrected Claim or Appeal?
Submit a corrected claim if the original charges were incorrect. If the payer processed in error, contact them for an adjustment rather than appealing.
Preventing Future 94 Denials
- Ensure all charges are accurate before claim submission.
- Avoid submitting duplicate claims for the same service date.
- Regularly audit claims to catch and correct overcharges before submission.
- Communicate with payers to resolve any processing system issues.