CO 8 Denial Code

CPT-code is in-consistent with the provider-type or specialty(Taxonomy). When a healthcare provider bills a procedure code that does not match their designated type/specialty (taxonomy), it can lead to potential issues such as claim denials with CO 8 denial code.

Usually, CO 8 Denial Code will be accompanied with the RARC code N95 – which means this provider type/provider specialty may not bill this service.

Common reasons for the CO 8 Denial Code are as follows:

• When a claim is billed with an incorrect provider type or specialty, it can result in the procedure code being perceived as unreliable by the insurance company. This mismatch can lead to the denial of the claim with the CO 8 denial code. It is crucial for healthcare providers to ensure that the provider type and specialty information on the claim form accurately reflect the services being provided.
• When a claim is submitted with an incorrect or outdated taxonomy code.
• When a claim is billed with a lack of supporting documentation that corresponds to the procedure code submitted.
• When a healthcare provider renders services outside of their authorized scope of practice, it can lead to claims being denied with a CO 8 denial code. This denial code signifies that the provider is not qualified to perform the specific healthcare services billed. It is crucial for healthcare providers to adhere to their authorized scope of practice to ensure quality care and proper billing practices. Billing for services that a provider is not qualified to perform not only results in denied claims but also raises concerns regarding the standard of care being provided to patients.
• When a coding team assigns an incorrect procedure code that leads to an inconsistency with the provider type or specialty.

To address this CO 8 denial code effectively, healthcare providers should take the following steps:

• When encountering a CO 8 denial code, it is crucial to verify that the taxonomy code is correctly included on the HCFA 1500 claim form. Ensuring that the taxonomy code is present in both box 24J (rendering provider) and box 33B (billing provider) is essential before submitting the form to the insurance company for adjudication. The taxonomy code identifies the specific type of healthcare provider or specialist involved in the care rendered, and its accuracy is vital for proper reimbursement and claim processing.
• When processing healthcare claims, it is crucial to verify that the provider type/specialty or taxonomy code billed is accurate. If the claim is submitted with incorrect information, it is essential to promptly address this issue by updating the correct provider type/specialty or taxonomy code and resubmitting the claim as a corrected claim.
• If the provider type/specialty or taxonomy code is accurate, then we need to verify a provider’s specialty on the NPPES website,

To verify a provider’s specialty on NPPES website, follow these steps:

1. Go to the National-Plan & Provider-Enumeration-System (NPPES) website.

2. Enter the rendering provider’s NPI number.

3. Look for the provider specialty information under the primary taxonomy section.

4. Once you have identified the provider specialty, the next step is to cross-reference and review this specialty with the Current Procedural Terminology (CPT) code billed for the services rendered.

• When encountering a situation where the procedure code billed is valid and consistent with the provider’s specialty, it is crucial to take steps to ensure proper reimbursement. In such cases, it is recommended to send the claim back for reprocessing by contacting a representative of the insurance claims department.
• If the procedure code billed does not correspond with the provider’s specialty, then we need to send the claim to coding team to check the accuracy of the procedure code in relation to the medical documentation available.
• When the coding team discovers that the procedure code billed does not align with the medical documentation, it is crucial to rectify the error promptly. The correct procedure code should be updated based on the information in the medical documents. Subsequently, the corrected claim should be resubmitted to ensure accurate billing and proper reimbursement.
• When the coding team verifies that the procedure code billed aligns with the medical documentation and the claim is submitted with the appropriate provider type/specialty or taxonomy code yet receives a denial with CO 8 denial code, it is crucial to collaborate with the client to determine the root cause of the denial and take necessary actions to rectify the issue.