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226
CO - Contractual ObligationCoding/Billing
Denial Code CO-226: Service Not in Plan Network
What Does Code 226 Mean?
The information submitted does not support the day and room charges. The payer disagrees with the room and board charges submitted on the institutional claim.
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?
Room charges do not match the authorized level of care or exceed the allowed rate.
How to Resolve It
- 1Verify the room charge matches the authorized level of care
- 2If observation, ensure correct billing format
- 3Appeal with documentation supporting the room charges
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