How do I resolve a CO-174 denial?

Pull the original claim and review the denial reason and any RARC codes Research the payer's policy for CARC 174 to understand the basis for denial See full resolution steps at tryarceum.com.

Can I appeal a CO-174 denial?

Yes. Most CO-174 denials can be appealed within 60-180 days depending on payer. This is appealable if a valid prescription existed prior to service delivery but was not submitted or if documentation can prove the prescription requirement was met. Use our free tool to generate an appeal letter.

CARC Code

174

🔴 Hard Denial

Service Not Prescribed Before Delivery

The claim was denied because the service or item was provided to the patient without a valid prescription being written beforehand. The payer requires a prescription to be on file before the service date.

authorization

Resolution: 35%Hard difficulty21-45 days avg

How to resolve this denial

Which payer denied this claim?

Review how the service must be billed; correct and resubmit per plan guidelines

1
Pull the original claim and review the denial reason and any RARC codes
2
Research the payer's policy for CARC 174 to understand the basis for denial
3
Gather supporting documentation addressing the denial reason
4
Submit a formal appeal with the documentation within the plan's appeal window
5
Follow up on the appeal within 30 days and document all communication

Resolve this denial →

▶✓ Pre-action checklist — verify before contacting the payer

Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.

▶More about CO-174 — stats, related codes, appeal template

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Payer-Specific Notes

How major payers handle CARC 174 by specialty.

Blue Cross Blue Shield

BCBS requires appeal submission within 180 days for most plans.

Appeal Letter Template

Generic appeal template for CARC 174 denials.

We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 174 indicating: "Service(s) are not covered as billed.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.

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