CARC 275 Active

CO-275: Prior Payer Patient Responsibility Not Covered

TL;DR

CO-275 is a contractual obligation. Review the adjustment details and determine whether to accept it or file an appeal.

Action
Review & Decide
Who Pays
Provider
Appeal
No
Patient Impact
None
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does CO-275 Mean?

When paired with Group Code CO, CARC 275 becomes a contractual obligation between the provider and payer. The adjustment relates to prior payer patient responsibility not covered. The provider absorbs this amount as a contractual adjustment and cannot post as a contractual adjustment for it.

CARC 275 appears in multi-payer scenarios — typically when a secondary or tertiary payer processes a claim and determines that the patient responsibility amount left by the prior payer is not covered under their plan. The patient's deductible, coinsurance, or copayment from the primary payer remains the patient's obligation.

This code is exclusively used with Group Code PR, making it clear that the patient bears the financial responsibility. It most commonly surfaces on claims where the primary payer has already adjudicated and left a balance that the patient expected the secondary plan to pick up. In practice, many patients with dual coverage assume the secondary payer will cover whatever the primary did not, but that is not always the case.

Before billing the patient, verify that the coordination of benefits information is accurate across both payers. Incorrect patient demographics or COB data can cause the secondary payer to inappropriately deny coverage of the patient responsibility amount.

How to Resolve

  1. Review the adjustment details Examine the CO-275 adjustment and accompanying RARC codes on the remittance advice.
  2. Verify the adjustment is correct Review the claim, contract terms, and supporting documentation to determine if the adjustment was properly applied.
  3. Determine the appropriate action Based on your review, decide whether to accept the adjustment as a contractual obligation or file an appeal with supporting documentation.
  4. Process accordingly Post the adjustment or file an appeal based on your determination.
  5. Follow up Monitor the outcome and take further action if needed.
Do Not Appeal This Code

Prior Payer Patient Responsibility Not Covered reflects a coverage determination — the service falls outside the plan's covered benefits as written. Coverage carve-outs per the plan terms aren't typically reversible by appeal; review the plan documentation and accept the adjustment if the determination matches the plan.

How to Prevent CO-275

Also Filed As

The same CARC 275 may appear with different Group Codes:

PR-275 OA-275

Related Denial Codes

CO-19 — Workers' Compensation Claim CO-20 — Liability Carrier Responsible CO-21 — No-Fault Carrier Responsible CO-22 — Coordination of Benefits - Another Payer May Cover CO-23 — Prior Payer Adjudication Impact

Sources

  1. https://www.mdclarity.com/denial-code/275
  2. https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.