CO-285: Appeal Procedures Not Followed

What Does CO-285 Mean?

CO-285 means the appeal was procedurally rejected as a contractual matter. The payer did not review the appeal on its merits because it did not meet their procedural requirements. The provider must correct the appeal submission and resubmit following the proper procedures. The underlying denial remains unresolved.

CARC 285 is a procedural rejection of an appeal — not a decision on the appeal's merits. The payer is saying your appeal was not considered because it did not follow their required submission procedures. The underlying claim denial has not been reviewed on substance.

This is a frustrating but fixable denial. Common procedural failures include submitting the appeal through the wrong channel (mail vs. electronic), using the wrong forms, omitting required supporting documentation, skipping a required level of appeal (e.g., going directly to second-level review without completing first-level), or not addressing the appeal to the correct department. Each payer has specific appeal procedures, and what works for one payer may not work for another.

The critical point is that your appeal window may still be open — CARC 285 does not necessarily mean you have lost the right to appeal. However, the clock is ticking. Review the denial letter immediately, obtain the payer's complete appeal procedure documentation, and resubmit a properly formatted appeal within the remaining timeframe. If the appeal deadline has passed due to the procedural rejection, request an extension citing the circumstances.

Common Causes

How to Resolve

Identify which appeal procedures were not followed, correct the submission to meet all requirements, and resubmit within the remaining appeal window.

1. Review the procedural rejection Read the denial notice to understand exactly which appeal procedures were not followed.
2. Obtain complete procedures Get the payer's full appeal requirements including forms, format, documentation, submission channels, and appeal levels.
3. Rebuild the appeal Prepare a new appeal that fully complies with every procedural requirement. Include all required documentation.
4. Submit properly Send the corrected appeal through the correct channel, addressed to the right department, within the remaining timeframe.
5. Confirm receipt Contact the payer to confirm they received the resubmitted appeal and it meets their procedural requirements.

How to Prevent CO-285

• Maintain a reference guide of each payer's appeal procedures, forms, and submission requirements
• Use standardized appeal checklists to verify all requirements are met before submission
• Train staff on payer-specific appeal procedures and update training when procedures change
• Verify appeal submission requirements with the payer before sending when procedures are unclear

General Prevention

• Maintain a reference guide of each payer's specific appeal procedures, including required forms, documentation, and submission channels
• Develop standardized appeal workflows with checklists to ensure all requirements are met before submission
• Train staff on payer-specific appeal requirements and update training when procedures change
• Implement a tracking system to monitor appeal submissions and deadlines
• Verify appeal submission requirements with the payer before sending if procedures are unclear
• Keep copies of all appeal submissions and track confirmation of receipt

Related Denial Codes