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Last Modified: 10/14/2022 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 PECOS external link.
Note: A provider’s Medicare effective date can be retroactive up to 30 days from receipt of application, or, for 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. Refer to the Provider Enrollment page for additional 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 CMS website.
Refer to the list of tests granted waived status under CLIA external pdf file to determine if the procedure code you’re billing requires the modifier QW (CLIA waived test).
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 SPOT or the Interactive Voice Response (IVR).
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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.