Not paid when billed by this type of provider
The payer does not pay this provider type (for example a nurse practitioner, a therapist, or a lab) for this service.
CO = Contractual Obligation. The provider owes the difference. The patient cannot be billed for this amount. The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- Provider type not credentialed for the service or the benefit.
- Service limited by the payer to physicians or to a specific specialty.
- Rendering provider is not enrolled with the payer and the claim went out under their NPI.
The fix
Check the provider's enrollment and the payer's policy. If the wrong rendering NPI was used, correct it. If the provider is not enrolled, enroll them (and hold their claims until they are). If the provider is eligible and the payer is wrong, appeal with license and enrollment proof.
Appeal or corrected claim?
Corrected claim for a wrong NPI; appeal with enrollment proof when the provider is eligible.
Deadline to watch
Timely filing limit; appeal window per payer.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-170 in short
What does CO-170 mean?
The payer does not pay this provider type (for example a nurse practitioner, a therapist, or a lab) for this service. The official X12 text reads: "Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."
What usually causes a CO-170 denial?
Provider type not credentialed for the service or the benefit. Service limited by the payer to physicians or to a specific specialty. Rendering provider is not enrolled with the payer and the claim went out under their NPI.
How do I fix CO-170?
Check the provider's enrollment and the payer's policy. If the wrong rendering NPI was used, correct it. If the provider is not enrolled, enroll them (and hold their claims until they are). If the provider is eligible and the payer is wrong, appeal with license and enrollment proof.
Should I appeal CO-170 or send a corrected claim?
Correct or appeal (see note). Corrected claim for a wrong NPI; appeal with enrollment proof when the provider is eligible.
What deadline applies to CO-170?
Timely filing limit; appeal window per payer.