Denial Code CO 276 - Fix & Appeal Steps
Code 276 means that the services were originally denied by a previous payer and are also not covered by the current payer. This indicates a gap in coverage or a coordination of benefits issue between payers.
Who Pays: Group Code Liability
For code 276, liability often falls under the CO group code, indicating a contractual write-off where the patient cannot be billed. However, if the denial is due to a non-covered benefit or patient responsibility under their plan, it could be PR, making it billable to the patient. Verify with the payer's policy to determine the correct group code.
Why Claims Get Code 276
- The primary payer denied the claim, and the secondary does not cover the service.
- Coordination of Benefits (COB) information was incomplete or incorrect.
- The service is not included in the patient's plan coverage.
- The secondary payer requires additional documentation that was not provided.
- The patient did not meet the eligibility criteria for the service under their current plan.
How to Fix & Resubmit
- Verify the denial reason from the prior payer to understand why they denied the service.
- Check the patient's plan details with the current payer to confirm if the service is covered.
- Ensure that Coordination of Benefits (COB) information is correctly updated and submitted.
- Contact the patient to clarify any missing or incorrect COB information.
- Submit a corrected claim if COB information was updated, or provide necessary documentation if required by the payer.
Corrected Claim or Appeal?
For code 276, submit a corrected claim if there was an issue with Coordination of Benefits or missing documentation. If the service is not covered by the patient's plan, an appeal is unlikely to succeed and may not be warranted.
Preventing Future 276 Denials
- Ensure Coordination of Benefits information is accurate and up-to-date before submitting claims.
- Verify coverage details with both primary and secondary payers prior to service.
- Educate patients on the importance of providing complete and accurate insurance information.
- Regularly update and verify patient eligibility and plan coverage details.