CO-295Contractual ObligationPayment Adjustment
CO-295 Denial Code: Pharmacy DIR fee
Direct/Indirect Remuneration fee assessed on pharmacy claims — the post-adjudication fee pharmacies know too well.
Why CO-295 happens
- ●PBM DIR/performance fee applied
How to fix a CO-295 denial
- 1
Reconcile DIR against contract terms; dispute miscalculations through the PBM process
How to prevent it
Model DIR exposure per contract; recent rules move DIR to point-of-sale.
Drowning in CO-295 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.