CO-276: Prior Payer Denied Services Not Covered by This Payer
CO-276 means the secondary payer is not covering services denied by the primary payer. Appeal with documentation showing the secondary payer should evaluate coverage independently.
What Does CO-276 Mean?
When paired with Group Code CO, the secondary payer is contractually declining coverage for services denied by the prior payer. The provider absorbs the cost and cannot transfer it to the patient. Appeal if the secondary payer's benefit plan should independently cover the service.
CARC 276 appears when the secondary (current) payer denies coverage for a service that was already denied by the primary (prior) payer. The secondary payer is declining to provide coverage because the primary payer's denial effectively establishes that the service is not covered, and the secondary payer's policy does not override that determination.
This cascading denial is common in coordination of benefits situations where both payers have similar coverage exclusions, the secondary payer's policy defers to the primary payer's coverage decisions, or the secondary payer lacks sufficient documentation to make an independent coverage determination.
The appeal strategy for CARC 276 focuses on demonstrating that the secondary payer should evaluate coverage independently, regardless of the primary payer's decision. If the secondary payer's benefit plan covers the service, the fact that the primary payer denied it should not automatically result in a secondary denial.
Common Causes
| Cause | Frequency |
|---|---|
| Current payer follows prior payer's denial determination The current (secondary) payer denies coverage because the prior (primary) payer already denied the service, and the secondary payer's policy does not override prior payer denials | Most Common |
| Service not covered under secondary payer's plan The service that was denied by the primary payer is also not covered under the secondary payer's benefit plan | Common |
| Insufficient documentation for secondary payer review The secondary payer lacks sufficient documentation to independently review and potentially cover the service that the primary payer denied | Common |
| Coordination of benefits cascade denial The denial cascades from the primary to secondary payer due to COB rules that prevent the secondary payer from covering services the primary payer determined were not covered | Common |
How to Resolve
- Review the primary payer's denial details Understand the specific reason for the primary payer's denial.
- Gather documentation from both payers Compile denial letters, medical records, and coverage information from both primary and secondary payers.
- Review secondary payer's independent coverage Check whether the secondary payer's benefit plan covers the service regardless of the primary payer's decision.
- File an appeal with the secondary payer Submit an appeal with the primary denial letter, comprehensive medical records, and a letter explaining why the secondary payer should cover the service.
- Monitor appeal progress Track the appeal and provide additional documentation as requested.
File an appeal with the secondary payer including the primary payer's denial letter, comprehensive medical records, medical necessity documentation, and a cover letter explaining why the secondary payer should independently cover the service. Reference the secondary payer's specific benefit plan provisions that support coverage.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-276:
| RARC | Description |
|---|---|
| N381 | Alert: Consult your contractual agreement for restrictions, billing, and payment information. Review the secondary payer's policy on covering services denied by the primary payer → |
| N479 | Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer). Submit the primary payer's denial letter/EOB to support the secondary claim → |
How to Prevent CO-276
- Verify eligibility with both primary and secondary payers before service delivery
- Obtain necessary pre-authorizations from both payers when required
- Maintain thorough documentation that supports medical necessity independently for each payer
- Communicate clearly with payers about coverage when submitting secondary claims
- Stay current on individual payer policies regarding coverage of services denied by prior payers
Also Filed As
The same CARC 276 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/276
- https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.