CO-147 denial code
Provider contracted rate expired or is not on file
How to fix it
Contact provider relations to confirm contract status and effective dates, then request reprocessing.
How to prevent it
Track contract expiry and renewal dates. An expired contract silently converts in-network claims to out-of-network.
In practice
A practice notices that reimbursement from one commercial payer has dropped across the board. Reviewing the remittances, the adjustments carry CO-147: provider contracted rate expired or is not on file.
The contract lapsed at renewal. Nobody at the practice tracked the expiry date, and the payer's notice went to an address that had not been updated since the group moved offices.
Every claim submitted since the lapse has been processed at out-of-network or default rates. Reprocessing requires the contract to be reinstated, ideally retroactively, and then a bulk reprocessing request — which payers grant but which takes months.
What sits behind it
CO-147 is the most financially serious code on this page precisely because it is not dramatic. Claims are paid. Nothing sits in accounts receivable. The only symptom is that the amounts are wrong, and unless allowed amounts are being compared against contracted rates, nothing surfaces it.
That is the same detection problem as CO-45 underpayments, and it has the same answer: contracted rates loaded in the practice management system and reconciled automatically at payment posting. A practice that cannot state its contracted rate for a given code and payer cannot detect a lapsed contract at all.
The second exposure is the patient's. An expired contract makes the practice out-of-network for that plan, which changes patient cost-sharing and, depending on the plan and the state, may engage balance billing rules under the No Surprises Act. A lapse that goes unnoticed for months creates a compliance problem alongside the revenue one.
Related codes
Terms used here — Contractual Adjustment · Allowed Amount · Underpayment
How we handle it — Provider Credentialing · Practice Analytics · Revenue Cycle Management
Primary sources
The rules behind CO-147, at the bodies that publish them.
- Medicare Physician Fee Schedule lookup (opens in a new tab)
Centers for Medicare & Medicaid Services — Official allowed amounts by CPT/HCPCS code and locality. The reference point most commercial contracts are written against as a percentage.
- No Surprises Act guidance (opens in a new tab)
Centers for Medicare & Medicaid Services — Balance billing restrictions, good faith estimates and the independent dispute resolution process — all of which change what a practice may bill a patient.
- Medicare Claims Processing Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — The operative manual for how Medicare claims must be coded, submitted, adjusted and appealed. When a payer policy and a vendor's advice disagree, this settles it.
Every denial code with a guide
Authorization
Bundling
Contractual
- CO-45A Contractual Adjustment
- CO-253Sequestration Reduction
- CO-147Contracted Rate Expired
- CO-222Contracted Unit Cap Exceeded
Coverage
Data quality
Documentation
Eligibility
Liability and workers comp
Patient responsibility
Provider eligibility
Timely filing
Looking for a different code? Search all 190 CARC and RARC codes
Questions about CO-147
Claims continue to be processed, but at out-of-network or default rates rather than contracted ones. Nothing sits unpaid in accounts receivable, which is why a lapse can run for months without being noticed.
Usually yes, if the contract is reinstated retroactively. Request bulk reprocessing from provider relations once the effective date is confirmed. It is granted routinely but takes months to work through.
Load contracted rates into the billing system and reconcile allowed amounts against them at payment posting. Without that comparison there is no signal at all, because the claims are being paid.
Yes. It makes the practice out-of-network for that plan, which changes patient cost-sharing and may engage balance billing protections under the No Surprises Act depending on the plan and the state. That is a compliance exposure on top of the revenue loss.
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