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242
CO - Contractual ObligationProvider
Denial Code CO-242: Services Not Provided by Network Provider
What Does Code 242 Mean?
Services not provided by network/primary care provider. The service was rendered by an out-of-network provider.
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?
Patient was seen by an out-of-network provider without authorization.
How to Resolve It
- 1Verify network status
- 2Request a network exception if no in-network option was available
- 3Appeal with documentation of medical necessity for out-of-network care
- 4Check No Surprises Act protections for emergency services