CO-171: Payment Denied for Provider Type in This Facility Type

What Does CO-171 Mean?

With CO (Contractual Obligation), the CARC 171 adjustment is the provider's responsibility. The payer denied or reduced payment because of the payer restricts certain services to specific provider type and facility type combinations, and the claim's combination is not among those authorized. 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 171 indicates payment denied for provider type in this facility 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 restricts certain services to specific provider type and facility type combinations, and the claim's combination is not among those authorized; The place of service code on the claim does not match the actual facility where the service was rendered, creating an ineligible provider/facility combination; The facility where the service was performed is not credentialed or authorized by the payer for the type of service billed. The group code paired with CARC 171 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-171 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 authorized to bill in this facility setting, incorrect place of service code, facility not credentialed for the service type, among others.
3. Correct the claim Address the identified issue — update the claim data in your billing system to resolve the payment denied for provider type in this facility 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 showing the provider type is authorized to bill for this service in the specific facility type, including facility credentialing records, provider credentials, and payer policy references.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-171:

How to Prevent CO-171

• Verify that the place of service code accurately reflects the facility where the service is rendered
• Confirm provider type and facility type compatibility with payer policies before billing
• Maintain accurate facility NPI records in the billing system
• Review payer-specific rules for provider/facility combinations when setting up new service locations
• Use claim scrubbing tools to flag incompatible provider type and place of service combinations before submission

Also Filed As

The same CARC 171 may appear with different Group Codes:

Related Denial Codes