Denial code · Contractual Obligation (CO)
CO-242 denial code
The service was not given by a provider in the payer's network, or not by the person's main provider.
What the code means
Official meaning: Services not provided by network/primary care providers.
In plain words: The service was not given by a provider in the payer's network, or not by the person's main provider.
The usual fix
Check if the provider is in network and if a referral was needed, fix the provider or referral facts, and send the claim again corrected.
This is general information, not advice on a specific claim.
Learn on the job
Learn on the job with real denied claims.
Working denied claims is the medical claims desk's daily work. Read a code, find what is missing, fix the claim, or write the appeal.