CO-170: Payment Denied for This Provider Type

What Does CO-170 Mean?

With CO (Contractual Obligation), the CARC 170 adjustment is the provider's responsibility. The payer denied or reduced payment because of the payer's policy restricts the billed service to specific provider types, and the billing provider's type is not among those eligible to perform or bill for this service. The patient is not liable for this amount. If the denial is in error, the provider can correct and resubmit the claim or file an appeal with supporting documentation.

CARC 170 indicates payment denied for this provider type. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the payer's policy restricts the billed service to specific provider types, and the billing provider's type is not among those eligible to perform or bill for this service; The payer has the wrong provider type classification in their enrollment records, causing eligible services to be denied; The taxonomy code on the claim does not match the provider type that the payer allows for this service. The group code paired with CARC 170 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

Common Causes

How to Resolve

1. Review the remittance details Examine the CO-170 adjustment and any accompanying RARC codes to identify the specific reason for the denial.
2. Identify the root cause Determine which issue applies: provider type not eligible to bill for this service, incorrect provider type on file with payer, provider taxonomy code mismatch, among others.
3. Correct the claim Address the identified issue — update the claim data in your billing system to resolve the payment denied for this provider type problem.
4. Resubmit the corrected claim Submit the corrected claim following the payer's resubmission guidelines. Include any supporting documentation that addresses the denial reason.
5. Appeal if the original claim was correct Appeal with documentation of the provider's credentials, license, and taxonomy code showing the provider type is eligible to perform and bill for the service. Include payer policy references that confirm eligibility.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-170:

How to Prevent CO-170

• Maintain accurate provider type and taxonomy codes in payer enrollment records
• Verify payer-specific provider type requirements before billing services
• Ensure provider credentialing records are current and reflect the correct provider type
• Use the correct taxonomy code on claims that matches the billing provider's actual type
• Review payer policies when adding new services to determine provider type eligibility

Also Filed As

The same CARC 170 may appear with different Group Codes:

Related Denial Codes