CO-27: Expenses Incurred After Coverage Terminated

What Does CO-27 Mean?

With CO (Contractual Obligation), the CARC 27 adjustment is the provider's responsibility. The payer denied or reduced payment because of the date of service is after the patient's insurance coverage end date. 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 27 indicates expenses incurred after coverage terminated. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the date of service is after the patient's insurance coverage end date; Patient's coverage was retroactively terminated to a date before the service; Patient's employer coverage ended and COBRA was not elected or payments lapsed. The group code paired with CARC 27 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-27 adjustment and any accompanying RARC codes to identify the specific reason for the denial.
2. Identify the root cause Determine which issue applies: service date after coverage termination, coverage terminated retroactively, cOBRA not elected or lapsed, among others.
3. Correct the claim Address the identified issue — update the claim data in your billing system to resolve the expenses incurred after coverage terminated 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 If the payer has an incorrect termination date, appeal with documentation showing the correct coverage end date, such as COBRA election forms, employer confirmation, or marketplace enrollment records.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-27:

How to Prevent CO-27

• Verify insurance eligibility before every visit
• Check coverage status for patients who have not visited recently
• Use real-time eligibility verification tools
• Flag patients with recently terminated coverage

Also Filed As

The same CARC 27 may appear with different Group Codes:

Related Denial Codes