skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 11/28/2018 Location: FL, PR, USVI Business: Part B

Denial reason code CO/PR B7 FAQ

Q: We received a denial with claim adjustment reason code (CARC) CO/PR B7. What steps can we take to avoid this denial?
Provider was not certified/eligible to be paid for this procedure/service on this date of service.
A: You received this denial for one of the following reasons: 1) the date of service (DOS) on the claim is prior to the provider’s Medicare effective date or after his/her termination date, 2) the procedure code is beyond the scope of the provider’s Clinical Laboratory Improvement Amendment (CLIA) certification, or 3) the laboratory service billed is missing a required modifier.
To prevent this denial in the future:
Submit claims for services rendered on/after the provider’s effective date and prior to the provider’s termination date.
Double-check the DOS on your claim.
Confirm the provider’s enrollment information through the internet-based Provider Enrollment, Chain and Ownership System (PECOS) external link.
Note: A provider’s Medicare effective date can be retroactive up to 30 days from receipt of application, or a future date, up to 60 days from receipt of application.
If you require additional assistance regarding a provider’s effective or termination date, you may contact Provider Enrollment. Click here for more information.
If you’re billing for a laboratory service, verify that the service/procedure code is listed as approved under the scope of the provider’s CLIA certification, and if a modifier is required, add a valid modifier to the claim.
Refer to the complete list of downloads of Categorization of Tests external link on the Centers for Medicare & Medicaid Services (CMS) website.
Refer to the List of Waived Tests external pdf file on the CMS website to determine if the procedure code you’re billing requires the modifier QW (CLIA waived test).
For assistance, you may review the CLIA - CPT codes requiring modifier QW tutorial.
Resubmitting your claim:
If an error was made, make the necessary correction, and resubmit corrected line item(s) only. Resubmitting non-corrected line item(s) will result in a duplicate claim denial. If a reopening request is applicable, you may submit your request, via the Secure Provider Online Tool (SPOT) or the Interactive Voice Response (IVR).
Source: First Coast Education Action Team
list item Please use your browser's back button to return to the referring page.
list item
Source: First Coast Education Action Team
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.