Referral absent
The plan requires a referral from the primary care provider for this service and the payer has none on file.
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
- HMO or point-of-service patient seen without a referral.
- Referral exists but the referring provider or referral number is missing from the claim.
- Referral issued to a different provider or expired.
The fix
If a referral exists, add it and send a corrected claim. If not, ask the primary care provider for a retroactive referral and resubmit. Verify referral requirements at scheduling for HMO patients.
Appeal or corrected claim?
Corrected claim when the referral exists; retro referral then resubmission; appeal with clinical reason otherwise.
Deadline to watch
Retro referral windows are short; timely filing applies to the resubmission.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-288 in short
What does CO-288 mean?
The plan requires a referral from the primary care provider for this service and the payer has none on file. The official X12 text reads: "Referral absent"
What usually causes a CO-288 denial?
HMO or point-of-service patient seen without a referral. Referral exists but the referring provider or referral number is missing from the claim. Referral issued to a different provider or expired.
How do I fix CO-288?
If a referral exists, add it and send a corrected claim. If not, ask the primary care provider for a retroactive referral and resubmit. Verify referral requirements at scheduling for HMO patients.
Should I appeal CO-288 or send a corrected claim?
Correct or appeal (see note). Corrected claim when the referral exists; retro referral then resubmission; appeal with clinical reason otherwise.
What deadline applies to CO-288?
Retro referral windows are short; timely filing applies to the resubmission.