Code lookup
BCBS Denial Codes, CARCs and Fix Paths
Search common BCBS denial codes and open a workflow page for corrected claims, appeals, attachments, COB, authorization and payment disputes.
| Code | Plain-language issue | Category | Recommended path |
|---|---|---|---|
| CO-4 | Modifier/procedure mismatch | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-5 | Procedure or bill type inconsistent with place of service | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-6 | Procedure or revenue code inconsistent with patient age | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-7 | Procedure or revenue code inconsistent with patient gender | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-8 | Procedure code inconsistent with provider type or taxonomy | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-11 | Diagnosis inconsistent with procedure | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-15 | Authorization number missing, invalid, or not applicable | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-16 | Claim or service lacks information or has billing errors | Missing, invalid, or incomplete information | Corrected claim or document response first; appeal only when the original submission was complete. |
| CO-18 | Exact duplicate claim or service | Missing, invalid, or incomplete information | Corrected claim or document response first; appeal only when the original submission was complete. |
| CO-22 | Care may be covered by another payer under COB | Coordination of benefits and other payer liability | COB record update, primary EOB submission, or secondary claim correction. |
| OA-23 | Impact of prior payer adjudication | Contractual adjustment, fee schedule, and underpayment | Post as contractual adjustment if correct; dispute only when the allowed amount or pricing basis is wrong. |
| CO-26 | Expenses incurred before coverage | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-27 | Expenses incurred after coverage terminated | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-29 | Time limit for filing has expired | Timely filing and appeal deadlines | Payment dispute or appeal with proof of accepted timely submission. |
| CO-31 | Patient cannot be identified as insured | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-35 | Lifetime benefit maximum reached | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-39 | Services denied when authorization was requested | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-40 | Charges do not meet emergent or urgent care qualifications | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-45 | Charge exceeds fee schedule or contracted allowance | Contractual adjustment, fee schedule, and underpayment | Post as contractual adjustment if correct; dispute only when the allowed amount or pricing basis is wrong. |
| CO-49 | Routine/preventive exam or screening not covered in this context | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-50 | Service not deemed medically necessary by payer | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-51 | Non-covered service due to pre-existing condition | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-54 | Multiple physicians or assistants not covered in this case | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-55 | Experimental or investigational service | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-56 | Treatment not proven effective by payer | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-58 | Invalid or inappropriate place of service | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-59 | Processed under multiple or concurrent procedure rules | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-60 | Outpatient services not covered near inpatient services | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-66 | Blood deductible adjustment | Contractual adjustment, fee schedule, and underpayment | Post as contractual adjustment if correct; dispute only when the allowed amount or pricing basis is wrong. |
| CO-70 | Cost outlier adjustment | Contractual adjustment, fee schedule, and underpayment | Post as contractual adjustment if correct; dispute only when the allowed amount or pricing basis is wrong. |
| CO-78 | Non-covered days or room charge adjustment | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-95 | Plan procedures not followed | Appeal procedure and time limit issues | Procedural review and exception request if the appeal process or deadline was missed. |
| CO-96 | Non-covered charges | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-97 | Benefit included in payment for another service | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-107 | Related or qualifying claim/service not identified | Missing, invalid, or incomplete information | Corrected claim or document response first; appeal only when the original submission was complete. |
| CO-109 | Claim or service not covered by this payer | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-112 | Service not furnished directly to patient or not documented | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-119 | Benefit maximum reached for time period or occurrence | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-129 | Prior processing information appears incorrect | Missing, invalid, or incomplete information | Corrected claim or document response first; appeal only when the original submission was complete. |
| CO-140 | Patient ID number and name do not match | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-146 | Diagnosis invalid for date of service | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-147 | Provider contracted or negotiated rate expired or not on file | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-148 | Information from another provider insufficient or incomplete | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-150 | Information submitted does not support this level of service | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-151 | Information submitted does not support this many or frequency of services | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-152 | Information submitted does not support this length of service | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-153 | Information submitted does not support this dosage | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-154 | Information submitted does not support this day supply | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-163 | Claim-referenced attachment or documentation not received | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-164 | Claim-referenced attachment not received timely | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-167 | Diagnosis is not covered | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-170 | Payment denied when performed or billed by provider type | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-171 | Payment denied by provider type in facility type | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-172 | Payment adjusted by provider specialty | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-177 | Patient has not met eligibility requirements | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-181 | Procedure code invalid on date of service | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-182 | Procedure modifier invalid on date of service | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-183 | Referring provider not eligible to refer service | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-184 | Ordering provider not eligible to order service | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-185 | Rendering provider not eligible to perform service | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-189 | Unlisted/NOC procedure billed when a specific code exists | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-193 | Original payment decision maintained after review | Appeal procedure and time limit issues | Procedural review and exception request if the appeal process or deadline was missed. |
| CO-197 | Precertification, authorization, notification, or pre-treatment absent | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-198 | Precertification, authorization, notification, or pre-treatment exceeded | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-199 | Revenue code and procedure code do not match | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-200 | Expenses incurred during lapse in coverage | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| PR-204/N130 | Service, equipment, or drug not covered under current benefit plan | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-204 | Service, equipment, or drug not covered under current benefit plan | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-206 | National Provider Identifier missing | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-207 | National Provider Identifier has invalid format | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-208 | National Provider Identifier not matched | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-210 | Precertification or authorization not received timely | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-216 | Based on payer or review organization findings | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-222 | Contracted maximum hours, days, or units exceeded | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-226 | Requested provider information not provided timely or complete | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-227 | Requested patient or insured information not provided | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-231 | Mutually exclusive procedures on same day or setting | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-234 | Procedure is not paid separately | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-236 | Procedure or modifier combination incompatible with another same-day service | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-239 | Claim spans eligible and ineligible coverage periods; rebill separately | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-242 | Services not provided by network or primary care providers | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-243 | Services not authorized by network or primary care providers | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-250 | Incorrect attachment or document received | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-251 | Attachment or documentation incomplete or deficient | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-252 | Attachment or documentation required to adjudicate claim | Attachments, records, and documentation requests | Document response or corrected attachment reference; appeal if documentation was already received and sufficient. |
| CO-256 | Service not payable per managed care contract | Contractual adjustment, fee schedule, and underpayment | Post as contractual adjustment if correct; dispute only when the allowed amount or pricing basis is wrong. |
| CO-261 | Procedure or service inconsistent with patient history | Medical necessity and clinical review | Clinical appeal with policy-matched evidence. |
| CO-267 | Claim or service spans multiple months | Missing, invalid, or incomplete information | Corrected claim or document response first; appeal only when the original submission was complete. |
| CO-268 | Claim spans two calendar years; resubmit one claim per year | Eligibility, member ID, coverage period, or plan mismatch | Eligibility/member-data correction first; appeal if coverage was active and verified. |
| CO-272 | Coverage or program guidelines were not met | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-273 | Coverage or program guidelines were exceeded | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-279 | Services not provided by preferred network providers | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-282 | Procedure/revenue code inconsistent with type of bill | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
| CO-284 | Authorization number may be valid but does not apply to billed services | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-285 | Appeal procedures not followed | Appeal procedure and time limit issues | Procedural review and exception request if the appeal process or deadline was missed. |
| CO-286 | Appeal time limits not met | Appeal procedure and time limit issues | Procedural review and exception request if the appeal process or deadline was missed. |
| CO-287 | Referral exceeded | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-288 | Referral absent | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-299 | Billing provider not eligible to receive payment | Provider enrollment, taxonomy, specialty, or network eligibility | Provider-data correction or enrollment escalation before appeal. |
| CO-300 | Medical plan forwarded claim to behavioral health plan | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-301 | Submit services to behavioral health plan | Non-covered benefit or plan exclusion | Benefit and policy review first; appeal only when coverage language supports payment. |
| CO-302 | Authorization or notification time limit expired | Prior authorization, referral, or notification | Authorization audit first; appeal when authorization existed, was not required, or payer applied it incorrectly. |
| CO-306 | Type of bill inconsistent with patient status | Bundling, coding edits, modifiers, and NCCI-style denials | Coding review first; corrected claim or payment dispute only when documentation supports separate payment. |
Current CARC update snapshot
| CARC | Official description snapshot | Status |
|---|