CO-47: Payment Suspended Pending Review
CO (Contractual Obligation)What is CO-47?
CO-47 is a Contractual Obligation code indicating the payer has suspended payment pending further review. The claim is under investigation. This could be a medical review, fraud investigation, or documentation request.
Why Does CO-47 Occur?
- Payer requesting additional documentation before releasing payment.
- Claim flagged for medical necessity review or utilization review.
- Claim under fraud or abuse investigation.
- Payer conducting a post-payment audit.
How to Fix CO-47 Denials
- Check the RARC code to determine what the payer needs.
- Submit requested documentation promptly to the payer's review department.
- Follow up on the review status within 30 days.
- If the review takes longer than 30 days with no resolution, file a complaint with the state insurance commissioner.
CO-47 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | Varies | 60 days from remittance | Reconsideration required before formal appeal. |
| Anthem | Varies | 365 days from denial notice | Check state-specific provider manual for variations. |
| Aetna | Varies | 180 days from denial | Strict in-network filing enforcement. |
| Cigna | Varies | 180 days from denial | Cigna COB team: 1-800-244-6224. |
| Medicare | Varies | 120 days (redetermination at MAC) | Five levels of appeal starting with MAC redetermination. |
Related CARC Codes
If you are seeing CO-47, check these related codes: CO-16 (claim differs), CO-45 (fee schedule), CO-29 (timely filing).
Common Questions About CO-47
What does CO-47 mean?
CO-47 indicates payment suspended pending review. Check the RARC code on the EOB for the specific reason and follow the resolution steps above.
Can I appeal a CO-47 denial?
Yes. Commercial payers allow 60-365 days to appeal depending on the payer. Gather supporting documentation before filing. Medicare allows 120 days for a redetermination request.
Altair catches CO-47 denials before submission with claim status tracking. See how pre-submit claim scoring works.