CO-147: Contract or negotiated rate has expired

The payer is telling you the rate used on the claim was tied to a contract or single-case agreement that has ended. They are not honoring that rate and are pricing the claim under different terms, usually standard out-of-network or default fee schedules. Mechanically, the pricing system checks your contract ID, network status, or single-case-agreement dates against the date of service. If the date falls outside the effective dates, the system reprices the claim and posts CO-147 for the difference between what you billed or expected and what the payer now allows, and that amount is a contractual write off.

In behavioral health, CO-147 shows up a lot when a single-case agreement for residential, PHP, or detox ends and the facility keeps billing under the old rate. For example, a 30-day residential SUD SCA is approved, but the client stays 45 days and days 31 to 45 price at a much lower default out-of-network rate with CO-147 on the reduction. It also hits IOP and PHP when a facility moves from an old contracted per-diem to a new negotiated rate, and the billing system does not update the contract dates or payer fee schedule. Claims that cross the contract change date get split, and the tail end is repriced with CO-147. You will also see this with telehealth psychotherapy or MAT visits when you had temporary COVID-era rate agreements or state Medicaid emergency waivers that paid in-person rates for telehealth. Once those special arrangements expire but your charge master and expectations stay the same, the repricing engine tags the old rate portion with CO-147.

• Check the payer portal or your contract file to confirm the effective and end dates of the contract or single-case agreement that applies to the member and level of care.
• Compare the dates of service on the denied lines to the contract dates and see which days fall after the expiration.
• If services were actually authorized and contracted beyond the listed end date, gather the signed contract addendum, SCA extension emails, and updated authorization showing the extended period.
• If the contract truly expired, update the expected allowed amount in your system, adjust off the CO-147 balance as contractual, and do not bill the patient.
• If the payer is ignoring a valid, active contract or SCA extension, submit a corrected claim only if the payer requires a different contract ID or billing indicator, otherwise file a formal appeal with contract documents and payer correspondence attached.
• For ongoing levels of care like residential, PHP, or IOP, coordinate with utilization review to confirm whether days after the expiration should be moved to another payer, billed as cash pay, or discharged earlier to avoid further non-contracted days.

• Maintain a central contract and SCA log with payer, product, rate, and start and end dates, and share it with billing and utilization review.
• Configure your practice management or billing system with contract-effective dates so the system warns when days of service fall past a contract or SCA end date.
• At verification and authorization, confirm whether there is an active behavioral-health contract or SCA for the planned length of stay and document any temporary or COVID-era rate arrangements with their end dates.
• Before submitting claims that span long stays in residential, PHP, or detox, split claims at contract or SCA change dates and use the correct payer, network status, and expected rate for each span.