Insurances Company will be denying the claim with Denial Code CO 05 – Procedure code/Bill Type is inconsistent with the Place of Service, whenever the CPT code is not compatible with the place the health care service provided to patient.
Now let us understand the below terms to understand the Denial Code CO 05 – Procedure code/Bill Type is inconsistent with the Place of Service.
Procedure Code: Procedure code is a 5 character code (numeric or alpha numeric) used to describe the healthcare services/treatment provided by the healthcare provider/ hospital. Procedure Code indicated on HCFA 1500 in field location 24D.
Bill Type: Bill Type is a 3 digit code, which describes the type of bill a provider is submitting to insurance. Bill Type is used on UB 04 claims in field locator 4.
Place of Service: Place of Service is also called as POS and it is a 2 digit code, which designates where the actual health care services rendered to patient (Examples: Home, Hospital, office, clinic, etc.) Place of Service indicated on HCFA 1500 in field location 24B.
What Can One Do If the Claim Has Been Rejected Under This Code?
- In case the code is rejected under the Denial reason code CO-5, it is possible that you can reclaim it. However, in that case, it is equally important that you first check with the coding team if there are any kind of coding mishaps.
- Get them checked thoroughly and only then can you be extra sure. If you see that the codes mentioned are correct, get in touch with the insurance company and check on the reasons behind the rejection.
- Call the insurance company and ask to rep about the denial and also confirmed with him/her that our coding team ensured the procedure code (CPT) is consistent with the place of service (POS) so request to reprocess the claim.
- If the insurance rep does not send a claim for reprocessing then ask him/her for an appeal with appropriate documents and also confirm the Appeal address, timely filing limit of appeal, and call reference number as well.
Call insurance company claims department and ask below details for Denial Code CO 5
- Whenever you call claims department, always collect claim received and denial date from the representative?
- Next step is to verify with the rep, correct place of service for the procedure code billed or for the bill type reported. (If the procedure billed is incorrect then forward the claim to coding team to correct the claim and resubmit the claim as corrected claim).
- Get the corrected claim mailing address or fax number?
- If suppose submitted claim is correct and rep refuses to reprocess the claim, then you have rights to appeal the claim with supporting documents for reimbursement. Collect the address for appealing the claim/fax number for appealing and time frame required to appeal the claim?
- Finally get the claim number for reference.
FAQ-Frequently Asked Questions
Can the rejections under the CO-5 Denial code be reclaimed?
Yes, you can easily reclaim if your insurance was rejected under the CO 5 Denial code. However, in that case, you’ll have to recheck or either correct the code. In case it was already correct, get in touch with the insurance company then and there.
What does the CO 5 Denial code stand for?
The CO 5 Denial code in the simplest words, stands for those claims where the type of procedures are not made in terms of consistency with the bill type.
My code is right but still, it was rejected under the CO-5 Denial code. What should I do?
If you have reviewed and checked that your code was right and still it was denied under the CO-5 Denial code, get in touch with the insurance company today. They will ensure the right kind of assistance for an easy solution to your problems.
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