Who has to pay after a code 147 denial?

Usually the provider's problem — not yours. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.

How long do I have to appeal?

It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.

All denial codes · code 147

Denial code 147: what it means — and how to fight it

Denial code 147 (shown on your EOB as CO-147 or PR-147) means: “Provider contracted/negotiated rate expired or not on file.” In plain English: The plan has no current price agreement on file for this provider, so the claim stalled.

high appealability Usually the provider's problem — not yours

What they're really saying

“Provider contracted/negotiated rate expired or not on file.”

The plan has no current price agreement on file for this provider, so the claim stalled.

Your odds

Strong — this type of denial has real weaknesses.

Usually fixed between the provider and the plan without you paying more.

Fewer than 1 in 100 denied claims are ever appealed. When people do appeal, roughly 4 in 10 win the first round — and independent external review overturns 40–50% of what reaches it.

How to appeal a code 147 denial

Decode. You just did — this page is step one.
Set your clock. 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, only 65 for Medicare Advantage.
Urgent? If this is care you still need, call and request an expedited appeal — they must decide within 72 hours.
Tell the billing office in writing not to bill you while they resolve their contract with the plan. This is a contract problem between the two of them. Tell the provider in writing that you should not be balance-billed while they sort it out. If the provider was listed as in-network in the plan's directory on the day you booked, save a screenshot — many states require the plan to honor in-network cost sharing when the directory was wrong.
Send it certified. Letter plus evidence, keep copies of everything.
Escalate. Denied again? Independent external review — a doctor who doesn't work for your insurer decides.

Do it in minutes, free

The AppealClock tool translates your denial, drafts your appeal letter, computes your exact deadline — and watches the clock so you don't have to. No account. Your medical details never leave your device.

Start your appeal & set your clock →

Common questions

What does denial code 147 mean?: The plan has no current price agreement on file for this provider, so the claim stalled.
Can I appeal a CO-147 or PR-147 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are high: Usually fixed between the provider and the plan without you paying more. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 147 denial?: Usually the provider's problem — not yours. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.
How long do I have to appeal?: It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.