CO-252 denial code
The payer won't decide the claim until it gets supporting documentation.
“An attachment/other documentation is required to adjudicate this claim/service. …”
Start 09/30/2012 · Last modified 06/02/2013 · X12 adjustment reason code list
What it usually means in behavioral health
A run of CO-252s across one level of care or one code often means the payer has put the program on prepayment review. Treat it as an audit, not a paperwork glitch.
The remark codes name what's needed. A focused, indexed packet that answers the payer's criteria gets further than the whole chart.
Common causes
- Payer policy requires records for the code or level of care
- Program placed on prepayment review
- Attachment sent without the claim control number or in the wrong channel
Correct and resubmit, or appeal?
Send the documentation the remark codes ask for, through the channel the payer names, tied to the claim. If the pattern spans many claims, set up a prepayment-review response workflow.
What to do
Read the remark codes for the documentation required.
Assemble a focused, indexed packet that answers the payer's criteria.
Send it through the payer's attachment channel with the claim reference.
Track whether CO-252s cluster by code or level of care.
Often seen with
- M127
- N517
Got a CO-252 on your desk?
Send us the facts on that one denial — codes, payer, level of care, and dollar amount, no patient information — and within 2 business days we’ll tell you whether to correct or appeal, the deadline to watch, and what evidence would answer it. Free.