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136
CO - Contractual ObligationCoverage
Denial Code CO-136: Claim Not Covered - Plan/Benefit Exclusion
What Does Code 136 Mean?
Claim or plan/benefit is not included in the current plan. The service falls under an exclusion in the patient's specific benefit plan.
Group Code CO (Contractual Obligation): The provider has agreed to accept the payer's determination. The patient is generally not responsible for this amount.
Why Does This Happen?
The patient's plan explicitly excludes this type of service or benefit.
How to Resolve It
- 1Verify the plan exclusion with the payer
- 2Check if an alternative covered service exists
- 3Inform the patient of their plan limitations
- 4Request a plan exception with medical necessity documentation
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