835 Denial Combination
CO-120
Contractual Obligation · Claim-Level Adjustment
What This Combination Means
The patient must use providers from within the managed care network. The billed provider is not in the patient's assigned network or plan.
30%
Appeal Success
21-45 days
Avg. Resolution
Hard
Difficulty
Yes
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-120 combination — not generic advice.
- 1
Confirm the provider's network status in the patient's specific plan.
- 2
If the provider is in-network, submit proof of participation and appeal.
- 3
If the provider is out-of-network, verify whether the patient had emergency circumstances (No Surprises Act may apply).
- 4
If elective OON: inform the patient of their OON financial responsibility.
Specialty Context
How CO-120 typically presents across different practice types.
Dental
Verify the patient must use providers from within the managed care network per your dental plan contract and documentation requirements.
Medical
Confirm the patient must use providers from within the managed care network against payer policy and submit corrected claim as needed.
Behavioral Health
Apply behavioral health parity rules and confirm the patient must use providers from within the managed care network per MHPAEA standards.
Individual Code References
View the standalone definition for each code in this combination.
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