Category summary: Validate member identity, coverage dates, dependent status, product, and payer routing before deciding that this is an appeal.
Top codes in this category
CO-6Procedure or revenue code inconsistent with patient ageCO-7Procedure or revenue code inconsistent with patient genderCO-26Expenses incurred before coverageCO-27Expenses incurred after coverage terminatedCO-31Patient cannot be identified as insuredCO-109Claim or service not covered by this payerCO-140Patient ID number and name do not matchCO-177Patient has not met eligibility requirementsCO-200Expenses incurred during lapse in coverageCO-239Claim spans eligible and ineligible coverage periods; rebill separatelyCO-268Claim spans two calendar years; resubmit one claim per year
How to work these denials
- Compare the ID card, 270/271 eligibility response, claim demographics, and payer routing information.
- Correct subscriber name, member ID, date of birth, relationship, prefix, and dependent indicators.
- Split claims when dates span eligible and ineligible periods or calendar-year requirements apply.
- Use the correct payer ID/local Blue plan based on the member card and plan rules.
- Appeal with eligibility proof when coverage was active and the payer denied incorrectly.
Evidence checklist
- ID card copy
- Eligibility response
- Member demographics
- Coverage effective/termination dates
- Payer ID evidence
- Corrected claim notes