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CO-B7
Recoverability: Medium
This provider was not certified/eligible to be paid for this procedure/service on this date of service
The payer's records show the rendering provider was not credentialed, enrolled, or otherwise eligible for payment on the date of service. This is common with new associates whose credentialing lagged their start date.
Why this happens on dental claims
- New associate dentists treating patients while payer credentialing applications are still pending
- Claims billed under the wrong provider or location NPI, creating a mismatch with the payer's enrollment file
- Recredentialing lapses when a payer's revalidation notice went unanswered
How to appeal CO-B7
- Determine the provider's actual credentialing status and effective date with that payer
- If the payer backdates credentialing to the application date, as many do, request reprocessing of the gap-period claims once approval lands
- If the claim was billed under the wrong provider or location, correct it and resubmit
- Appeal with the credentialing timeline documented, and hold associate claims for payers that never backdate
How to prevent it
- Start payer credentialing 90 to 120 days before an associate's first patient day, and track effective dates per payer
- Decide per payer whether to hold, reassign, or schedule around providers who are not yet credentialed
Related codes
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