835 Denial Combination
CO-3
Contractual Obligation · Service-Line Level Adjustment
What This Combination Means
The service is covered at a different benefit level — the type of service submitted is covered, but under different plan provisions (e.g., preventive vs. diagnostic).
65%
Appeal Success
7-14 days
Avg. Resolution
Medium
Difficulty
Yes
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-3 combination — not generic advice.
- 1
Review the clinical indication for the service — was it for a preventive purpose or a diagnostic/treatment purpose?
- 2
The correct classification determines the patient's cost-share (preventive services are ACA-required at no cost).
- 3
Recode the service as preventive (with appropriate CPT and ICD-10) if it qualifies.
- 4
If diagnostic, apply the patient's deductible and coinsurance accordingly.
Specialty Context
How CO-3 typically presents across different practice types.
Dental
Verify the service is covered at a different benefit level — the type of service submitted is covered, but under different plan provisions (e per your dental plan contract and documentation requirements.
Medical
Confirm the service is covered at a different benefit level — the type of service submitted is covered, but under different plan provisions (e against payer policy and submit corrected claim as needed.
Behavioral Health
Apply behavioral health parity rules and confirm the service is covered at a different benefit level — the type of service submitted is covered, but under different plan provisions (e per MHPAEA standards.
Individual Code References
View the standalone definition for each code in this combination.
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