CO-176Contractual Adjustment
Patient has not met the required eligibility requirements
What this code means
The insurer determined you do not meet the plan eligibility criteria for this service. This could be age, enrollment status, or other requirements.
What to do next
Review the eligibility requirements for this service in your plan documents. If you believe you meet the requirements, appeal with documentation of your eligibility. Contact your HR department if this is an employer plan.
Appeal outlook: Moderate with documentation
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