Payment is denied when performed/billed by this type of provider

Why this happens on dental claims

• Medical plans denying dentists for services such as CBCT imaging, biopsies, or sleep appliances that the plan restricts to physician specialties
• Services rendered by a hygienist or expanded-function assistant billed under plans that limit those codes to dentists
• Claims billed under a provider whose taxonomy code on file does not match the service category

How to appeal CO-170

1. Confirm the rendering provider and taxonomy code submitted on the claim match reality and the payer's records
2. If the taxonomy or provider data was wrong, correct it and resubmit
3. Appeal with state scope-of-practice law and licensure documentation when the provider is legally authorized to perform the service
4. If the plan categorically excludes the provider type, route future cases through a credentialed referral relationship instead

How to prevent it

• Keep taxonomy codes current with every payer, and verify provider-type coverage before cross-billing medical plans