CO 183 Denial Code: Fix Referring Provider Issues

Why Claims Get Code 183

• The referring provider's credentials were not updated or verified correctly in the payer's system.
• The referring provider is not enrolled with the payer or does not have the required specialty designation.
• The service billed requires a referral from a specific type of provider, which was not adhered to.
• An incorrect or outdated provider identifier was used on the claim.
• The payer's policy does not recognize the referring provider for the service billed.

How to Fix & Resubmit

1. Verify the referring provider's credentials and eligibility with the payer for the service billed.
2. Contact the payer to confirm the requirements for referring providers for the specific service or procedure.
3. Correct the referring provider information if it was entered incorrectly on the original claim.
4. Update the claim with the correct referring provider details and resubmit if applicable.
5. If necessary, obtain a referral from an eligible provider and submit a new claim.

Preventing Future 183 Denials

• Ensure all referring providers are credentialed and eligible with each payer.
• Regularly update and verify provider information in your billing system.
• Educate staff on payer-specific requirements for referring providers.
• Implement a verification step for provider eligibility before claim submission.