CO-174: Service Not Prescribed Prior to Delivery

What Does CO-174 Mean?

With CO (Contractual Obligation), the CARC 174 adjustment is the provider's responsibility. The payer denied or reduced payment because of the physician's order or prescription was obtained after the service was already delivered, and the payer requires the order to be in place before the service is performed. The patient is not liable for this amount. If the denial is in error, the provider can correct and resubmit the claim or file an appeal with supporting documentation.

CARC 174 relates to service not prescribed prior to delivery. The payer requires specific authorization, certification, or referral for this service, and the claim was adjusted because that requirement was not satisfied.

Common scenarios that trigger this adjustment include: the physician's order or prescription was obtained after the service was already delivered, and the payer requires the order to be in place before the service is performed; The provider obtained a retroactive physician's order but the payer does not accept retroactive prescriptions for this type of service; The service was provided on an emergency basis without a prior prescription, but the payer does not recognize the emergency exception or documentation was insufficient. The group code paired with CARC 174 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment.

Common Causes

How to Resolve

1. Review the remittance details Examine the CO-174 adjustment and any accompanying RARC codes to identify the specific reason for the denial.
2. Identify the root cause Determine which issue applies: prescription obtained after service was rendered, retroactive order not accepted by payer, emergency service without prior prescription documentation, among others.
3. Correct the claim Address the identified issue — update the claim data in your billing system to resolve the service not prescribed prior to delivery 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.
5. Appeal if the original claim was correct Appeal with the dated physician's order showing it was obtained before the service was delivered. For emergency services, include documentation of the emergency circumstances that necessitated service delivery before a formal order could be obtained.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-174:

How to Prevent CO-174

• Obtain physician orders before providing services that require them
• Implement verification workflows that confirm a valid order exists before scheduling or delivering services
• Track standing order expiration dates and renew them before they expire
• For urgent situations, document the clinical justification for providing service before a formal order is obtained
• Train staff on payer-specific requirements for timing of physician orders relative to service delivery

Also Filed As

The same CARC 174 may appear with different Group Codes:

Related Denial Codes