CO-185 denial code
The payer says the clinician listed as rendering provider isn't eligible to perform the service billed.
“The rendering provider is not eligible to perform the service billed. …”
Start 06/30/2005 · Last modified 07/01/2017 · X12 adjustment reason code list
What it usually means in behavioral health
Behavioral health workforces mix license types and pre-licensed associates, and payers differ on who can be the rendering provider. Some don't credential associates at all and require billing under a supervisor, and some limit services by license type, such as psychological testing.
When the remark code is N95, the payer is saying this provider type or specialty can't bill this service.
Common causes
- Associate or pre-licensed clinician billed as rendering where the payer doesn't allow it
- License type not eligible for the service billed
- Clinician not credentialed with this payer, or not linked to the billing group
- Supervision billing rules not followed
Correct and resubmit, or appeal?
If the clinician can't render for this payer, rebill under the payer's supervision or incident-to rules where they allow it. If the clinician is eligible, fix the enrollment record and appeal with the credentialing evidence.
What to do
Check the payer's rules for the clinician's license type and the service.
Confirm the clinician's enrollment and link to the billing group.
Rebill under supervision rules, or appeal with enrollment evidence.
Match scheduling rules to payer rules so ineligible pairings don't reach billing.
Often seen with
- N95
- N290
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