CO-147: Provider Contracted/Negotiated Rate Expired or Not on File
No contracted rate on file. Contact provider relations to verify the contract status, provide documentation, and request reprocessing. Cannot bill the patient.
What Does CO-147 Mean?
CO-147 is the only valid pairing for this code. The CO group code means this is a contractual issue — the provider is responsible for maintaining a valid contract with the payer, and when the rate expires or is missing, the provider cannot bill the patient for the unpaid amount. The provider must resolve the contract issue directly with the payer. If the contract is genuinely active, the denial should be overturned once the rate is loaded. If the contract expired, the provider needs to renegotiate before claims can be processed.
CARC 147 is a contract and enrollment issue. When this code appears, the payer is telling you that they cannot find a valid contracted or negotiated rate for your practice in their claims processing system. This can mean the provider's participation agreement expired, the contract was renewed but the new rates were not loaded into the payer's system, or the provider was never fully enrolled in the payer's network for the relevant tax ID or NPI.
The most common trigger is a lapsed contract — the provider's agreement with the payer reached its expiration date and was not renewed. During the gap between expiration and renewal, the payer has no rate to apply to incoming claims and rejects them with CARC 147. The second most common cause is a system loading issue — the contract is active on paper, but the payer's claims processing system was never updated with the current rates, usually due to an administrative oversight during the contracting process.
CARC 147 is used exclusively with Group Code CO, meaning the provider bears full responsibility for resolving the contract issue and cannot bill the patient for the denied amount. The financial impact can be significant if the contract lapse goes undetected — claims will continue to be denied until the rate is restored. Practices should treat CARC 147 as an urgent issue requiring immediate contact with the payer's provider relations department to determine the contract status and initiate resolution.
Common Causes
| Cause | Frequency |
|---|---|
| Provider contract expired and was not renewed The provider's participation agreement or contracted rate schedule with the payer expired and was not renewed in time, causing the payer to have no valid rate on file for processing the claim | Most Common |
| Payer system does not have the contracted rate loaded The contract may be active but the payer's claims processing system has not been updated with the current negotiated rate, resulting in a system inability to apply the correct payment amount | Most Common |
| Administrative errors in contract documentation Billing staff or the payer's provider relations department incorrectly entered or failed to update the contract information, creating a disconnect between the active contract and the payer's system | Common |
| Provider credentialing or enrollment lapse The provider's credentialing or enrollment with the payer lapsed, which caused the contracted rate to be removed from the payer's system even though the contract itself may still be valid | Common |
| Communication breakdown during contract renegotiation During contract renegotiation, the old rate expired before the new rate was finalized and loaded, creating a gap period where no valid rate exists in the payer's system | Common |
| Payer policy changes affecting rate structure The payer changed their fee schedule or rate structure, and the provider's contract was not updated to reflect the new terms, resulting in a rate mismatch | Occasional |
How to Resolve
Verify the contract status, contact the payer's provider relations department, and either provide documentation of the active contract or renegotiate expired terms.
- Verify contract dates Check your contract records for the current effective dates, expiration date, and whether auto-renewal provisions apply.
- Contact the payer Reach out to provider relations to determine why the rate is missing and what is needed to restore it.
- Provide documentation or renegotiate If the contract is active, send a copy. If expired, begin renegotiation immediately and discuss retroactive reprocessing.
- Request reprocessing of denied claims Once the rate is restored, request reprocessing of all claims denied during the gap period.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-147:
| RARC | Description |
|---|---|
| N130 | Alert: Review provider contract or participation agreement for rate and term information |
| N381 | Alert: Consult your contractual agreement for the applicable rate schedule |
How to Prevent CO-147
- Implement a contract management system with automated alerts that notifies staff at least 90 days before contract expiration
- After signing or renewing a contract, confirm with the payer that the new rates are loaded in their claims processing system before submitting claims
- Conduct periodic payment audits to detect rate discrepancies that may indicate a missing or expired rate
- Maintain copies of all current contracts and rate schedules for quick reference when issues arise
- Keep credentialing and enrollment current with all payers to prevent rate removal due to enrollment lapses
General Prevention
- Implement a contract management system with automated alerts that notifies staff well before contract expiration dates so renewals can be completed in advance
- Maintain a calendar of all payer contract expiration and renewal dates, and begin renegotiation at least 90 days before expiration
- Conduct periodic audits of claims payments to detect rate discrepancies that may indicate a missing or expired rate in the payer's system
- Keep copies of all current contracts and rate schedules readily accessible so they can be provided to payers quickly when issues arise
- Maintain open communication with payer provider relations departments and verify enrollment and credentialing status periodically
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/147
- https://www.combinehealth.ai/denial-codes/co-147-denial-code
- Codes maintained by X12. Visit x12.org for official definitions.