CO 284 denial code
Claim adjustment reason code 284. Often reported as CO 284.
Authorization does not match services
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 284 means
There is an authorization or precertification number, but it does not cover the services billed on the claim.
The payer is not saying the number is fake. It is saying the authorization was for something else, such as different procedure codes, a different number of units, or a different setting.
Compare what was approved with what was performed and billed. Often the procedure changed during care and the authorization was never updated.
Group codes seen with 284
On a remittance, 284 comes after a group code. These are the ones it is most often reported with:
- CO 284 (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
- The procedure performed differed from the one authorized.
- More units or visits were billed than were authorized.
- The authorization was for a different place of service or level of care.
What to do next
- Pull the authorization and compare codes, units, dates, and setting with the claim.
- Ask the payer to update or extend the authorization if its rules allow retroactive changes.
- Correct the claim if the wrong codes were billed, or appeal with records showing why the service changed.
Related codes
- 296 (reason code) Authorization not valid for this provider
- 302 (reason code) Authorization request window has passed
- 197 (reason code) No prior authorization on file
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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