GetMax

Claim adjustment reason code · Contractual obligation

CO-185
Rendering provider not eligible to perform the service

What CO-185 means

The provider listed as rendering is not eligible to provide this service under the plan.

The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.

Common causes

  • Provider not credentialed for the service
  • Wrong rendering provider on the claim

How to fix it

  1. Confirm the rendering provider and their enrollment
  2. Correct the provider or complete credentialing

Check the remark code (RARC) that came with the denial and the payer's own policy, since rules vary by payer and plan. This is a plain-English summary written by GetMax; the official code text is published by X12 at x12.org/codes.

Prevent it next time

Most denials are caused before the claim is sent. See 12 ways to reduce claim denials, or let our denial management team work them for you.

Let us work your denials.

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