CO 131 denial code
Claim adjustment reason code 131. Often reported as CO 131.
One-time discount for this claim
Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated .
What 131 means
The payer reduced this claim by a discount that was negotiated for this particular claim rather than under a standing contract.
The amount was taken off because of a one-off pricing deal on this claim. That often happens with single case agreements, out-of-network negotiations or repricing vendors who settle a rate for one patient or one episode of care.
It is usually reported as a contractual reduction. Before treating it as final, make sure someone in your office actually agreed to the discount and that the rate applied matches what was agreed.
Group codes seen with 131
On a remittance, 131 comes after a group code. These are the ones it is most often reported with:
- CO 131 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.
The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.
Common causes
- A single case agreement set a specific rate for this patient or admission.
- A repricing or negotiation vendor settled a discounted amount on an out-of-network claim.
- Your office accepted a negotiated offer by phone or letter and the payer applied it here.
What to do next
- Find the signed agreement or negotiation record for this claim and compare its rate with the allowed amount.
- If no one in your office agreed to the discount, contact the payer or repricer and ask for the source of the agreement.
- Post the reduction as a contractual adjustment only once the agreed terms match the payment.
Related codes
- 45 (reason code) Charge exceeds the allowed amount
- 132 (reason code) Demonstration project adjustment
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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