Official CARC description: “Claim specific negotiated discount.” Here’s what it actually means, why it fires, and how to get the claim paid.
A repricing entity took a discount off your claim — legitimate when a contract you signed authorises it, and a classic “silent PPO” problem when a rental network you never joined skims it.
Liability group: CO = Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Identify the entity taking the discount (EOB usually names the network)
Match it against your actual executed contracts
No contract? Demand the contractual basis in writing
Track which payers route through which repricers — patterns repeat
Strongly appealable when no contract exists: dispute in writing, demand the signed agreement authorising the discount, and bill at full allowed rates. Silent-PPO recoveries are real money.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
Claim specific negotiated discount. In practice: A repricing entity took a discount off your claim — legitimate when a contract you signed authorises it, and a classic “silent PPO” problem when a rental network you never joined skims it.
CO stands for Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Strongly appealable when no contract exists: dispute in writing, demand the signed agreement authorising the discount, and bill at full allowed rates. Silent-PPO recoveries are real money.