CO-284: Authorization Valid But Does Not Apply to Billed Services

What Does CO-284 Mean?

CO-284 means the provider is responsible for the authorization mismatch. The authorization exists but does not apply to the billed services. The provider must find the correct authorization, correct the claim, or obtain retroactive approval. The patient cannot be billed.

CARC 284 indicates that the precertification, authorization, notification, or pre-treatment number provided on the claim may be valid — meaning it exists in the payer's system — but it does not cover the specific services that were billed. The authorization was issued for different procedures, different dates of service, a different provider, or a different scope of treatment than what appears on the claim.

This is a nuanced denial because the provider did obtain authorization, just not the right one for the billed services. Common scenarios include: using an authorization that covers some but not all of the billed procedure codes, submitting a claim for services performed after the authorization expired, billing additional procedures beyond what was originally approved, or simply entering the wrong authorization number due to a clerical error.

The distinction between CARC 284 and a standard no-authorization denial (such as CARC 197) is important: with 284, the payer acknowledges an authorization exists but identifies a mismatch between that authorization and the claim. This typically means the fix is achievable — either locate the correct authorization number, request retroactive authorization, or demonstrate that the existing authorization should cover the billed services.

Common Causes

How to Resolve

1. Review the authorization Compare the authorized services, dates, and provider against the claim to identify the specific mismatch.
2. Locate the correct authorization If the wrong auth number was submitted, find the correct one and resubmit.
3. Request retroactive auth If no authorization covers the services, request retroactive approval from the payer with medical necessity documentation.
4. Resubmit with correct auth Submit the corrected claim with the right authorization number.
5. Appeal if retroactive auth is denied File an appeal with clinical records showing the services were medically necessary.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-284:

How to Prevent CO-284

• Verify authorization numbers match the specific services, dates, and provider before claim submission
• Track authorization expiration dates and obtain extensions before services are rendered
• Implement authorization verification in your billing system that flags mismatches before submission
• Obtain separate authorizations when services expand beyond the original scope

General Prevention

• Verify precertification applicability to the specific services being billed before claim submission
• Ensure authorization numbers are correctly entered and match the services on the claim
• Track authorization expiration dates and obtain renewals before they expire
• Train staff on proper precertification documentation and matching procedures
• Implement technology solutions to automatically verify authorization-service alignment before claim submission

Also Filed As

The same CARC 284 may appear with different Group Codes:

Related Denial Codes