CO-170 Denial Code is used when the payment is rejected for a service that was billed by a person who is not authorized for that type of service. To understand the cause of denial, you can send an 835 Healthcare Policy Identification Segment in the payment remittance advice.
Top Causes of CO-170
The causes of CARC 170 are:
i. Incorrect Provider Type
The payment may be rejected for a service that was billed by a person who is not authorized for that service. The reason behind this is a mismatch between service provider’s credentials and service which is being billed.
ii. Shortage of documentation
The denial may take place if the provider stops submitting the proper required documents and supporting informational documents along with the claim. It includes referral letters, incomplete medical records, or other important documents for the service provided.
iii. Non-Covered Service
Code 170 Denial may occur if the service details and procedures are not covered under the affected patient’s life insurance or any insurance plan. The providers must verify that the services which are provided are eligible for reimbursement.
IV. Coding Errors
Billing errors and coding errors are the causes of 170 denials. This could include wrong diagnosis codes, modifiers, and wrong procedure codes, which results in a claim being denied or rejected.
V. Duplicate Billing
Sending multiple claims for the same procedure can cause 170 denials. Service providers should make sure that they are not billing for a service more than once.
VI. Time Limits
Insurance companies have limited time frames within which service providers should submit their claims. If the claim is not submitted in a given time, it may be denied.
VII. Policy Changes and Updates
170 Denials can occur due to changes in reimbursements, coverage guidelines, or insurance policies.
Healthcare service providers must label these common or repeated causes of CO-170 denials to better their revenue cycle management.
How to Avoid CO-170 Denial Code?
Top ways to avoid CO-170 Denial Code:
i. Providers Credentials
Make sure that all the service providers are authorized and properly credentialed for the service they are going to bill.
ii. Regular Audits
Do audits regularly to identify the issues and errors related to provider types. This will help you to mark any issue perfectly and ensure necessary corrections before filing claims.
iii. Right Documentations
Make sure that all the documents, including claims and medical records. This will help reduce any type of mismatching and misinterpretations by payers.
iv. Staff Training
Provide the best training to your billing and coding staff to sure that they know the specific requirements for each service type. This will help them perfectly assign the accurate codes and prevent denials.
v. Stay Tuned
Stay tuned about any updates or changes in payer policies in each provider type. Check out payer websites regularly, newsletters, and others to ensure that you are up to date with changes.
vi. Advanced Technology
Execute advanced technology in medical billing and coding software that can help recognize any potential error about provider type.
By using these unique strategies service providers can lessen the risk of denials with code 170 and can get a handsome revenue cycle management.
How to Address Denial Code 170
Top steps to address CO-170 Denial Code:
- Review details: Carefully look at the claim to ensure that it is sent correctly and all the important information is added, also check all the potential errors and spaces that may lead to denials.
- Review provider type: Check and ensure that the provider type is matching with the service being billed. If the code tells that the payment is rejected because the wrong person was billing out there then double check the provider’s qualifications.
iii. Review Coding Errors: Check the coding properly which is used in services. Make sure that codes which are used in the provided services are correct and show the actual procedure performed. Solve the coding errors (if any) because they can cause denials.
- Assessment of Documents: Assess all the supporting documents along with the claim. Verify that it justifies accurately for the billed service. If the documentations are incomplete make sure to add all the supporting documents from the provider.
- Educate Providers: If denials are occurring that are related to provider type make sure to educate your providers about billing and coding to ensure that he/she knows correct billing. Offer providers proper guidance about how to avoid future denials.
Keep in mind, that addressing denials needs a high level approach that include verification, careful reviews and if important (appealing the decision) by following the strategies given above.
