RemitBench/Denial codes/CO-170

CO-170 denial code

Code 170 is a category rule. It is not about the individual, their enrolment or their credentials. This payer does not pay for that service when this type of provider bills it.

The code list's own wording: Payment is denied when performed/billed by this type of provider.

What it means: The payer has a rule attached to provider type. Whatever the individual's qualifications, the category they are filed under is not one that gets paid for this service.
Who owes the money: The practice CO normally. The patient did not choose the provider category on your claim, so this is not their cost.
Is appealing worth it: Rarely useful against the rule itself. Useful when the provider is filed under the wrong type, which is more common than it sounds.

Check what provider type the payer has on file. Provider taxonomy is set once at enrolment and then rarely looked at again. A provider filed under a category that does not match what they actually do will collect this denial forever, and nobody thinks to check a field that was correct on the day it was entered.

Why the payer sent it

The payer genuinely does not pay that service to that provider type.
The provider is filed under the wrong type or taxonomy.
The service should have been billed under a supervising provider.
The claim went out under a group identifier where an individual one was needed, or the reverse.
The payer changed its rules for that provider type.

Remark codes you will see with it

Remark code	What it adds
N95	This provider type or specialty may not bill this service. The clearest confirmation.
N130	Read the plan document. Its own page.

Remark code

What it adds

N95

This provider type or specialty may not bill this service. The clearest confirmation.

N130

Read the plan document. Its own page.

Read the letters in front of the 170

CO-170: Contractual obligation. Your write-off.
PI-170: Payer initiated. Not the patient's money.

What to do next

Ask what provider type and taxonomy the payer holds

A single question with a lasting payoff, because a wrong taxonomy affects every claim rather than this one.
Find out who can bill the service

If another provider in the practice can, that is the answer. If nobody can, you need to know before it happens again.
Check the supervision rules

Many of these become payable when billed under a supervising provider, and the requirements are specific enough to be worth getting in writing.

Codes that get mixed up with 170

Code	How it differs from 170
185	The rendering provider is not eligible for the service. About the individual. See CO-185.
B7	Not certified or eligible on that date. Enrolment. See CO-B7.
8	The procedure is inconsistent with the provider specialty. See CO-8.
171	Denied when performed by this provider type in this type of facility. Adds a place of service condition.

Code

How it differs from 170

185

The rendering provider is not eligible for the service. About the individual. See CO-185.

Not certified or eligible on that date. Enrolment. See CO-B7.

The procedure is inconsistent with the provider specialty. See CO-8.

171

Denied when performed by this provider type in this type of facility. Adds a place of service condition.

Code 170 in dental

Turns up when dental practices bill medical payers, because a medical plan's provider type rules often do not contemplate a dentist billing that service at all. It also appears for hygienists and dental therapists where a payer does not recognise the category.

Questions people ask about CO-170

Can this be fixed, or is the service simply not payable?

Both happen. First check what provider type the payer has on file, because a wrong taxonomy set at enrolment produces this denial permanently and is easy to correct. If the type is right and the rule is real, the question becomes whether another provider in the practice can bill it, or whether supervision rules allow it.

Related codes

Back to all denial codes

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