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CO-131
Recoverability: Low
Claim specific negotiated discount
An adjustment reflecting a discount negotiated for this specific claim, most often seen on out-of-network dental claims routed through third-party repricing or negotiation vendors.
Why this happens on dental claims
- Out-of-network claims repriced through rental networks or negotiation companies the office never agreed to work with
- Single-case discount agreements signed by the office, then applied more broadly than intended
- Silent PPO arrangements where a leased network's discount is taken without a direct contract
How to appeal CO-131
- Request the source of the discount: the specific agreement, network lease, or signed negotiation that authorizes it
- If your office never signed the underlying agreement, dispute the discount in writing and request reprocessing at the plan's out-of-network allowance
- If the discount is legitimate, confirm the patient's share was calculated on the discounted amount
- Review the lease and affiliate clauses in your network contracts to see how your fee schedule is being shared
How to prevent it
- Keep an inventory of every network contract and lease clause you have signed, and respond to single-case discount solicitations in writing only after review
Related codes
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