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174
CO - Contractual ObligationAuthorization
Denial Code CO-174: Service Not Authorized - Referral
What Does Code 174 Mean?
Service was not authorized by the primary care provider or required referral was not obtained.
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 HMO or gatekeeper plan requires a PCP referral that was not obtained.
How to Resolve It
- 1Obtain a retroactive referral from the PCP if possible
- 2Verify the patient's plan referral requirements
- 3Resubmit with the referral authorization number
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