835 Denial Combination
CO-196
Contractual Obligation · Service-Line Level Adjustment
What This Combination Means
The procedure is denied based on the submitted diagnosis — the diagnosis code does not support coverage for this procedure under the payer's medical policies.
60%
Appeal Success
14-30 days
Avg. Resolution
Medium
Difficulty
Yes
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-196 combination — not generic advice.
- 1
Review the ICD-10 code linked to the denied procedure on the claim.
- 2
Cross-reference the diagnosis with the payer's coverage policy for the procedure.
- 3
If the correct diagnosis was omitted, resubmit with the supporting diagnosis added.
- 4
If the diagnosis is correct, appeal with clinical notes demonstrating the procedure was necessary for this diagnosis.
- 5
Consider requesting a peer-to-peer review if the denial appears clinically unjustified.
Specialty Context
How CO-196 typically presents across different practice types.
Dental
Verify the procedure is denied based on the submitted diagnosis — the diagnosis code does not support coverage for this procedure under the payer's medical policies per your dental plan contract and documentation requirements.
Medical
Confirm the procedure is denied based on the submitted diagnosis — the diagnosis code does not support coverage for this procedure under the payer's medical policies against payer policy and submit corrected claim as needed.
Behavioral Health
Apply behavioral health parity rules and confirm the procedure is denied based on the submitted diagnosis — the diagnosis code does not support coverage for this procedure under the payer's medical policies per MHPAEA standards.
Individual Code References
View the standalone definition for each code in this combination.
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