CARC · CO group
CO-109
Claim not covered by this payer or contractor
Contractual obligation; provider write-off unless appealed
- What it means
- You sent the claim to the wrong payer or the wrong claims address.
- Likely cause
- Medicare Advantage plan billed as traditional Medicare, or a delegated behavioral health network missed at intake.
- How to fix it
- Re-verify the payer ID from the patient's card, then rebill to the correct entity. Watch the timely-filing clock, which is still running.
- Revenue impact
- Recoverable if caught quickly; becomes a CO-29 if it ages.
- wrong payer
- eligibility
- routing
Related codes
Early access
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