Code CO-B7
Problem Description
This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Actionable Fix — Solution Steps
Run BHSD 7521 Provider Credentialing Report to verify credentials are correct for provider: -Verify Provider's NPI is correct -Verify performing provider is effective on DOS -Verify POS is allowed for claimed service code -Verify provider's license type is allowed for service -If provider is not active, denial is valid -If changes need to be made to the effective date of the provider, contact BHSD Business Office and BHSD Credentialing
Related Codes in Contractual Obligation
The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)
This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.