CARC · CO group
CO-170
Payment denied when performed by this type of provider
Contractual obligation; provider write-off unless appealed
- What it means
- The rendering provider's type or license is not eligible to bill this service under the plan.
- Likely cause
- Pre-licensed associates or residents billed under their own NPI instead of the supervising provider, a very common group-practice failure.
- How to fix it
- Bill under the credentialed supervising provider where contracts allow, and keep a credentialing matrix by payer and license type.
- Revenue impact
- Large, systemic, and quietly expensive for growing group practices.
- credentialing
- supervision
- provider type
Related codes
Early access
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