CO-101: Predetermination: Anticipated Payment

What Does CO-101 Mean?

With CO (Contractual Obligation), the CARC 101 adjustment is the provider's responsibility. The payer denied or reduced payment because of the provider submitted a predetermination request, and CARC 101 on the response indicates the estimated payment amount the payer expects to pay when the actual claim is submitted. This is not a denial.. The patient is not liable for this amount.

CARC 101 appears on a remittance when the payer applies an adjustment for predetermination: anticipated payment. Review the group code and any accompanying RARC codes to understand the full context of this adjustment.

Common scenarios that trigger this adjustment include: the provider submitted a predetermination request, and CARC 101 on the response indicates the estimated payment amount the payer expects to pay when the actual claim is submitted. This is not a denial.; The anticipated payment on the predetermination is lower than the provider expected, possibly due to fee schedule rates, benefit limitations, or coverage restrictions identified during the predetermination review; The predetermination was obtained but the service was not rendered within the validity period, so the anticipated payment no longer applies and a new predetermination may be needed. The group code paired with CARC 101 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

Common Causes

How to Resolve

1. Review the remittance details Examine the CO-101 adjustment and any accompanying RARC codes to identify the specific reason for the denial.
2. Identify the root cause Determine which issue applies: standard predetermination response, predetermination amount differs from expected payment, predetermination expired before service rendered.
3. Correct the claim Address the identified issue — update the claim data in your billing system to resolve the predetermination: anticipated payment problem.
4. Resubmit the corrected claim Submit the corrected claim following the payer's resubmission guidelines. Include any supporting documentation that addresses the denial reason.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-101:

How to Prevent CO-101

• Submit predetermination requests well in advance of planned services to allow time for review
• Include complete clinical documentation with predetermination requests to get accurate anticipated payment amounts
• Track predetermination validity periods and render services before they expire
• Compare predetermination amounts against expected reimbursement to identify potential issues before service delivery
• File actual claims promptly after service delivery and reference the predetermination number

Also Filed As

The same CARC 101 may appear with different Group Codes:

Related Denial Codes