Denied by the prior payer, so not covered here
The secondary payer will not cover a service the primary payer denied.
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
- Primary denial for a correctable reason (CO-16, CO-29) that was never fixed with the primary payer.
- Primary payer excluded the service and the secondary follows the primary's decision.
The fix
Go back to the primary payer first: fix the claim or appeal there. Once the primary pays or issues a final decision, resend the secondary claim with the new primary remittance. If the secondary plan should cover the service independently (some Medicaid and supplemental plans do), appeal with the plan language.
Appeal or corrected claim?
Fix the primary claim first; appeal the secondary only when the secondary plan covers independently of the primary.
Deadline to watch
Primary payer's appeal and filing windows; secondary filing window usually counts from the final primary remittance.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-276 in short
What does CO-276 mean?
The secondary payer will not cover a service the primary payer denied. The official X12 text reads: "Services denied by the prior payer(s) are not covered by this payer."
What usually causes a CO-276 denial?
Primary denial for a correctable reason (CO-16, CO-29) that was never fixed with the primary payer. Primary payer excluded the service and the secondary follows the primary's decision.
How do I fix CO-276?
Go back to the primary payer first: fix the claim or appeal there. Once the primary pays or issues a final decision, resend the secondary claim with the new primary remittance. If the secondary plan should cover the service independently (some Medicaid and supplemental plans do), appeal with the plan language.
Should I appeal CO-276 or send a corrected claim?
Appeal. Fix the primary claim first; appeal the secondary only when the secondary plan covers independently of the primary.
What deadline applies to CO-276?
Primary payer's appeal and filing windows; secondary filing window usually counts from the final primary remittance.