CARC 147: Provider Contracted/Negotiated Rate Expired or Not on File

What it means

The payer processed the claim but has no current contracted rate on file for this provider, so it could not price the claim using a valid fee schedule. This usually means the payer's system shows the contract as expired, not yet loaded, or missing entirely for the billed service date.

Common causes

Provider contract with the payer has expired and has not been renewed or reloaded in the payer's system
New contract or rate amendment was signed but not yet updated in the payer's claims processing system
Claim was billed under a provider ID, tax ID, or NPI not linked to the active contract
Service date on the claim falls outside the effective dates of the contract on file
Provider recently changed group affiliation, location, or specialty, causing a break in the contract link
Payer credentialing or contracting file has a data entry error (wrong effective/termination date)

How to fix it

Contact provider relations or the network contracting department to confirm the current contract status and effective dates
Verify the date of service falls within an active contract period
Confirm the billing NPI, rendering NPI, and tax ID used on the claim match what is loaded under the active contract
If the contract was renewed or renegotiated, ask the payer to confirm the update was loaded and request a rebill or reprocessing once corrected
Check for any lapse in credentialing or re-credentialing that may have caused the contract to be deactivated
Resubmit or request reprocessing of the claim once the payer confirms the rate is active and on file

Appeal / resubmit

Before filing a formal appeal, contact provider relations to resolve the underlying contract/rate loading issue, since this is often an internal payer data problem rather than a coverage or coding issue. If you appeal, include a copy of the signed contract or amendment showing effective dates that cover the date of service, along with the remittance advice. Ask the payer to reprocess the claim administratively once the rate is corrected, rather than requiring a full appeal, if their policies allow it.

Related codes

Frequently asked

Does this code mean the patient's insurance is invalid?

No. It relates to the provider's contract status with the payer, not the patient's eligibility or coverage.

Can I just resubmit the same claim?

Resubmitting without resolving the contract issue will likely produce the same denial. Confirm the contract or rate has been updated on the payer's end first.

Who should I contact to fix this?

The payer's provider relations or network contracting department typically handles contract loading and rate file issues.

More free billing tools: all denial codes · denial lookup · Medicare fee calculator

This content is informational only and not billing or legal advice. Always verify current payer policies and consult a qualified billing or legal professional for specific situations.