Decoding Denials: Learn About CO-177

Decoding Denials for Healthcare RCM Teams

Understanding denial codes is a key task for RCM teams. Denial codes represent important information as to why certain claims may be getting denied. Each different code represents a specific reason for a denial and can create a path to recovering your missing revenue. It’s important for RCM teams to quickly understand denial codes so that you can implement strategies for preventing or responding to them in the future.

In this blog, we’re going to dive into the denial code CO-177 so that your team can be prepared to mitigate or respond to it moving forward.

What is Denial Code CO-177

Definition: Denial Code CO-177 means that the patient has not met the required eligibility criteria set by the insurance carrier for the services rendered. 

Common Cause of Denial Code CO-177

Cause: Denial Code CO-177 can occur as a result of multiple different mishaps. These can include:

• The patient does not meet the eligibility requirements for the services rendered
• Inadequate or missing supporting documentation
• Miscommunication with patients
• The provider has an expired license 
• The patient has expired medical coverage
• Lack of prior authorization
• Patient has reached limitation of times the services can be rendered
• Insurance requires alternative therapies ahead of services being rendered
• Coding error or typo

Responsibility: In this case, the portion of the code that says “CO” refers to the fact that it is a result of a contractual obligation. This means that the provider team needs to investigate the claim to understand why the claim does not align with the contract between themselves and the payer. 

Ways to Mitigate Denial Code CO-177

Prevention: Denial Code CO-177 can easily be avoided by taking precautions to ensure eligibility requirements are all met ahead of services being rendered.

• Verify that the patient is eligible for services 
• Verify that the patient’s insurance has not expired
• Check to see if services require a primary care referral
• Educate patients on eligibility requirements
• Streamline documentation processes
• Leverage technology to automate the eligibility process

How to Address Denial Code CO-177

Response: If you receive Denial Code CO-177, there are a few steps you can take to uncover and address the root of the problem. 

1. Review the patient’s medical records to ensure that eligibility, prior-authorization, and any other necessary requirements are being met. 
2. Identify if there are gaps and if so, a reason for the gap.
3. Contact the insurance company to understand the specific requirements for the claim and clear up any confusion so you don’t run into the same issue in the future.
4. Obtain missing documentation such as medical records, signatures, etc. 
5. Submit your appeal or corrected claim.
6. Track the progress of your appeal or corrected claim to ensure the appropriate documentation is accepted.

How Adonis Can Help

Verifying patient eligibility is a critical step in ensuring accurate and timely revenue outcomes. By confirming a patient's eligibility prior to providing services, healthcare organizations can avoid costly claim denials and reduce the risk of non-payment. Adonis automates the time-consuming process of verifying a patient's insurance coverage and benefits to ensure that the services being provided are covered under the patient's plan.With Adonis’ automations for eligibility, teams can avoid denial code CO-177.