The medical billing process is a bit more complicated than usual. Hence, it is very crucial that one does the right kind of research and then claims for the insurance. In this article, we will discuss CO8 denial code, which means The Procedure or CPT is inconsistent with the provider type or specialty (taxonomy).
Do remember one thing for every rejection there will be a code affixed. Based on this code it will be easier for you to deduce what is the primary reason why your claim got rejected and what you can do for a reaffirmation.
The CO variant of the denial code mostly stands for contractual obligation and hence it is necessary to consider that the patient is financially liable and sound. The CO 8 Denial Code stands for those claims which are rejected on the basis of inconsistency.
What does the CO8 Denial Code mean typically?
We have already discussed in great detail how the codes are very important and you should have a fair idea of the same to understand why your insurance got rejected.
- Once you have the idea you can also know about the things to do so that your claim gets accepted. The CO–8 Code for denial stands for the inconsistency with the type of provider or even the specialty sometimes.
- The Co 8 denial code means the provider who performed the procedures is not specialized or certified to perform these procedures.
- The code refers to the error in taxonomy and hence it is absolutely needed that the type of inconsistency is checked upon with details. In case that has been done and everything seems to be in place, you can either reclaim or you can get in touch with the provider.
- The CO code usually demarcates the obligation of the provider and so the codes help with more specifications. If you are of the opinion that everything was accurate with the claim and still it was rejected under the CO–8 Code, you need to contact the insurance provider at the earliest.
They will be able to guide you with the best way as to why the denial reason CO–8 was affixed.
How to Handle Co 8 Denial when Found in a claim?
If you are getting denial Co 8 – The CPT is inconsistent with the provider type or specialty (taxonomy) which means the procedure performed by the provider is not compatible with the provider’s specification.
Step by Step Process
Step 1: In this case, we have to first check the rendering provider NPI at the NPPES website. At NPPES we can get the taxonomy code. Contact the insurance company or payer and ask when the claim was denied. This information will help you track and reference the denial.
Step 2: If the Taxonomy code is the same as the claim form (HCFA 1500) or in the system and NPPES, called to the insurance company and request to rep send the claim to reprocess.
Confirm whether the provider’s specialty is not authorized to perform the service or if the taxonomy code is missing on the claim form.
Step 3: If the Taxonomy code is missing on the claim form, ask the rep of insurance if Taxonomy is present on a claim or not if yes then send for reprocess the claim and if not then need to resubmit the corrected claim with an updated taxonomy code which is found on NPPES website.
In claim form CMS 1500 form, the rendering provider’s taxonomy code is available on box# 24J, and the billing provider’s taxonomy code is available on box# 33b.
Step 4: Check for missing taxonomy code. Review the claim form to ensure the taxonomy code is included in the designated box. If the code is missing, this could be the reason for the denial.
Step 5: Confirm agreement for reprocessing. Verify if the representative agrees to reprocess the claim based on the provided information. Ensure they understand and acknowledge the alignment of the provider’s specialty and service.
Step 6: Obtain the claim and call reference numbers. Ask for the claim number and call the reference number associated with the denied claim. These numbers will be necessary for tracking and communication purposes.
Step 8: Inquire about the Turnaround Time (TAT) for reprocessing. Ask the insurance company or payer about the expected timeframe for reprocessing the claim. This will give you an idea of when to anticipate a resolution or further communication.
Note- If not able to find taxonomy on the NPPES website and also from the insurance rep in that case claim refers to the client for further clarification.
The concept of assigning codes to the instances makes the entire billing as well as insurance claim policy fluid and transparent. It helps the claimants to understand in detail what went wrong and why the claim was rejected in the first place.
One of the better things is that it also helps with the procedure and in most instances, you can reapply for the claim very easily.
FAQ- Frequently Asked Questions
Ans. Yes, the central concept of the CO 8 Denial Code focuses on the inconsistency with the variant of the provider. The code is very important for Medicare as well as other insurance claims and without its uniqueness, it can be confusing.
Ans. In case, your claim was rejected on the basis of the CO 8 Denial Code, The procedure is inconsistent with the provider means there is some certification issue, so we need to submit the provider’s certification to prove that provider is eligible to perform the services.
Ans. Although the claim stands denied, there is an easy option wherein you can reclaim it by making the necessary changes.
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