Category summary: Match billing, rendering, ordering, referring, supervising, attending, and service-facility data to the payer’s provider record.
Top codes in this category
CO-8Procedure code inconsistent with provider type or taxonomyCO-147Provider contracted or negotiated rate expired or not on fileCO-170Payment denied when performed or billed by provider typeCO-171Payment denied by provider type in facility typeCO-172Payment adjusted by provider specialtyCO-183Referring provider not eligible to refer serviceCO-184Ordering provider not eligible to order serviceCO-185Rendering provider not eligible to perform serviceCO-206National Provider Identifier missingCO-207National Provider Identifier has invalid formatCO-208National Provider Identifier not matchedCO-242Services not provided by network or primary care providersCO-279Services not provided by preferred network providersCO-299Billing provider not eligible to receive payment
How to work these denials
- Compare the 837 provider loops to payer enrollment, roster, taxonomy, location, and network/product records.
- Correct NPI/taxonomy/location fields if the claim is wrong.
- Open provider enrollment or credentialing escalation if the payer record is wrong.
- Attach roster effective dates, contract proof, and portal screenshots when disputing.
- Prevent recurrence by syncing PMS provider tables with the payer’s current provider file.
Evidence checklist
- Provider enrollment record
- NPI registry/taxonomy data
- Payer roster or contract proof
- Claim provider loops
- Portal screenshots
- Corrected claim notes