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172
CO - Contractual ObligationPayment Adjustment
Denial Code CO-172: Payment Adjusted - Contract Rate
What Does Code 172 Mean?
Payment is adjusted when performed/billed by a provider of this specialty/type. The contracted rate for this provider type results in a different payment.
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?
Different reimbursement rate applies based on provider specialty or type.
How to Resolve It
- 1Verify the contracted rate for your provider type
- 2If incorrect, dispute with contract documentation
- 3Ensure the correct provider taxonomy code is on the claim
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