CO-256: Not Payable Per Managed Care Contract
Service not payable per managed care contract. The payer has determined that this service is not reimbursable under the terms of the managed care contract.
Why Claims Get Denied with CO-256
Denial code CO-256 is triggered when service not payable per managed care contract. the payer has determined that this service is not reimbursable under the terms of the managed care contract. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
Service excluded from the managed care contract terms
Procedure not covered under the specific managed care product
Service requires network authorization that was not obtained
Managed care plan does not include this benefit category
How to Appeal CO-256
Review your managed care contract to confirm whether the service is truly excluded. If the service should be covered under the contract, provide the relevant contract language. If the denial is based on a network or authorization requirement, provide the necessary documentation. Contact the payer's provider relations department for contract interpretation.
Documentation Required for Appeal
A successful appeal of CO-256 requires thorough documentation. Gather these items before drafting your appeal letter:
Managed care contract showing covered services
Contract language supporting coverage of the service
Network authorization documentation (if applicable)
Provider relations department correspondence
How to Prevent CO-256 Denials
Maintain familiarity with the terms of each managed care contract. Verify covered services under the patient's specific managed care product. Obtain any required network authorizations before rendering services.
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