835 Denial Combination

CO-195

CO

Contractual Obligation · Claim-Level Adjustment

Contractual Obligation

What This Combination Means

This code appears when the payer has issued a refund to a previously identified coordination of benefits payer that should not have paid for the service. The current payer is documenting this refund transaction, and the provider must write off the amount per contractual terms. This typically occurs when coordination of benefits was incorrect and payment responsibility is being corrected between payers.

Financial Responsibility

reversal

The payer is refunding money to another insurance carrier that paid in error. The provider must write off this amount and cannot pursue payment from the patient or re-bill this amount.

N/A

Appeal Success

Immediate (write-off and accounting adjustment)

Avg. Resolution

Easy

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-195 combination — not generic advice.

Not Appealable:This is a payer-initiated refund transaction to correct coordination of benefits errors, not a payment determination subject to appeal.
  1. 1

    Verify the refund transaction against your payment records

    Confirm that a previous payment was received from an incorrect primary payer and that this refund amount matches that payment

  2. 2

    Post the contractual write-off adjustment in your billing system

    Apply the CO-195 adjustment to the claim to reflect the refund issued to the erroneous payer

  3. 3

    Reconcile coordination of benefits information for future claims

    Update patient insurance records to ensure correct payer priority to prevent recurrence of erroneous payments

Specialty Context

How CO-195 typically presents across different practice types.

Dental

Common when dual dental coverage (employer + spousal plans) requires coordination and one carrier paid out of sequence

Medical

Frequently seen in Medicare/commercial coordination scenarios or when patient changes primary coverage mid-treatment

Behavioral Health

May occur when EAP benefits were exhausted but a claim was paid against EAP in error and funds must be returned

Individual Code References

View the standalone definition for each code in this combination.

CARC 195

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Synthesized from official definitions — not from training data

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