CO 171 Denial Code - Provider/Facility Mismatch
Code 171 indicates that payment is denied because the service was performed or billed by a provider type not covered in the specific facility setting. This denial often occurs when a provider's specialty is not authorized to perform certain services in the facility where the service took place. The 835 Healthcare Policy Identification Segment may provide further details on the policy causing this denial.
Who Pays: Group Code Liability
For code 171, the group code is typically CO, meaning the provider must write off the charge and cannot bill the patient. This is a contractual denial based on provider type and facility mismatch.
Why Claims Get Code 171
- A specialist performed a procedure in a facility type not recognized by the payer for that specialty.
- The provider's NPI is not credentialed for the facility where the service was rendered.
- Billing was submitted with a provider type not allowed to perform the service in the facility.
- The facility type does not match the provider's registered place of service with the payer.
- A contractual agreement excludes payment for services by this provider type in this facility.
How to Fix & Resubmit
- Review the 835 Healthcare Policy Identification Segment to identify specific policy details.
- Check the provider's credentialing status and ensure it matches the facility type.
- Verify the place of service code on the claim aligns with the provider's approved settings.
- If credentialing or registration errors are found, update the provider's information with the payer.
- Submit a corrected claim if credentialing errors are resolved or contact the payer for guidance if a policy update is needed.
Corrected Claim or Appeal?
Submit a corrected claim if the issue was due to a credentialing error that has been resolved. If the denial is due to a hard policy restriction, a formal appeal may not be successful, and the claim may need to be written off.
Preventing Future 171 Denials
- Ensure providers are correctly credentialed for each facility type they practice in.
- Verify that the provider's NPI and specialty align with the place of service codes before claim submission.
- Regularly update provider and facility credentials with all payers.
- Educate billing staff about matching provider types with appropriate facility settings.