835 Denial Combination
CO-27
Contractual Obligation · Claim-Level Adjustment
What This Combination Means
The patient's insurance coverage was not in effect on the date of service — the policy was terminated or lapsed. This requires verifying coverage effective/termination dates and may require balance billing the patient or filing with a different payer if they had other coverage.
N/A
Appeal Success
7-14 days
Avg. Resolution
Medium
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-27 combination — not generic advice.
- 1
Run a real-time eligibility check for the exact date of service to confirm the coverage termination date.
- 2
Verify the patient does not have secondary coverage (spouse's plan, Medicaid) that may cover the service.
- 3
Confirm with the patient whether they were aware of the coverage lapse and if they have new insurance information.
- 4
If the patient had other coverage on the DOS: file with the new payer with the correct insurance information.
- 5
If no coverage exists: bill the patient directly for the services rendered per your financial policy.
Specialty Context
How CO-27 typically presents across different practice types.
Dental
Dental plan termination often occurs when employment changes. Verify the patient's coverage dates at the time of service.
Medical
Coverage may lapse due to non-payment of premium, open enrollment issues, or loss of employment. Re-run eligibility for the exact DOS.
Behavioral Health
Medicaid coverage gaps are common — confirm the patient had active Medicaid on the date of service using your state's eligibility portal.
Individual Code References
View the standalone definition for each code in this combination.
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