CO-287 Denials Explained: How to Identify, Appeal, and Prevent Them

Denial codes are a constant challenge for healthcare revenue cycle teams, and CO-287 is one that can significantly disrupt claims processing. This denial code is triggered when a diagnosis is inconsistent with the provider type, often due to a mismatch between the provider's taxonomy and the diagnosis submitted. Understanding CO-287 denials is critical to keeping revenue flowing and reducing operational burdens.

In this article, we’ll explain what CO-287 denials mean, compare them to similar codes, explore common causes, and provide actionable strategies to appeal and prevent these denials from impacting your bottom line.

What Is a CO-287 Denial?

CO-287 is a contractual obligation denial code indicating that the diagnosis submitted is inconsistent with the provider’s type or specialty. This mismatch arises when the provider’s taxonomy code does not align with the diagnosis on the claim. Taxonomy codes are standardized identifiers that define a provider’s specialty, and payers use them to validate claims.

The prefix "CO" signifies that the denial falls under contractual obligations, meaning the payer is not responsible for payment. In this case, the provider bears the financial responsibility for resolving the denial or absorbing the revenue loss.

Comparison: CO-287 vs Similar Denial Codes

Denial Code	Prefix Meaning	Reason/Description	Who's Financially Responsible
CO-287	Contractual Obligation	Diagnosis inconsistent with the provider type	Provider
CO-16	Contractual Obligation	Claim lacks information needed for adjudication	Provider
CO-253	Contractual Obligation	Inconsistent billing code with provider taxonomy	Provider

While CO-16 and CO-253 also involve taxonomy or claim issues, CO-287 specifically addresses mismatches between the diagnosis and the provider’s specialty. This distinction highlights the importance of validating taxonomy codes during claim submission.

Common Causes of CO-287 Denials

1. Incorrect Taxonomy Code: The provider’s taxonomy code submitted on the claim does not match their specialty or the diagnosis being billed.
2. Invalid Diagnosis Code: The diagnosis code listed is outside the scope of practice for the provider’s specialty.
3. Outdated Provider Enrollment Data: The provider's information in payer systems is incomplete or outdated, causing mismatches during claim adjudication.
4. Errors in Payer Rules: Payer-specific rules regarding taxonomy and diagnosis codes may not be properly accounted for during billing.
5. Inadequate Front-End Verification: Lack of robust processes for validating diagnosis and taxonomy codes before claim submission.

Impact on Revenue Cycle Teams

CO-287 denials can have serious financial and operational consequences for healthcare organizations:

Financial Impact:
- Loss of revenue from denied claims that require extensive rework.
- Increased accounts receivable days, reducing cash flow.
- Risk of write-offs if appeals are not submitted on time or are unsuccessful.
- Higher costs due to additional resources needed for denial management.

Operational Impact:
- Excessive staff time spent on denial resolution rather than proactive revenue cycle tasks.
- Need for specialized knowledge of payer-specific rules and clinical documentation.
- Increased coordination across billing, coding, and clinical teams to resolve denials.
- Difficulty tracking denial trends without robust analytics tools.

To mitigate these challenges, CombineHealth.ai’s Adam (AI Denial Manager) offers advanced denial tracking and resolution capabilities, enabling RCM teams to identify and resolve CO-287 denials efficiently.

Steps To Appeal a CO-287 Denial

Step 1: Review the Denial Notice
Carefully examine the explanation of benefits (EOB) or electronic remittance advice (ERA) to confirm the denial reason.

Step 2: Gather Documentation
Collect relevant supporting documents, including medical records, provider credentials, and the original claim submission.

Step 3: Verify Eligibility
Cross-check the provider’s taxonomy code and diagnosis code to ensure they align with payer requirements.

Step 4: Prepare Appeal Letter
Draft a clear, concise appeal letter that addresses the denial reason, includes supporting evidence, and requests reconsideration.

Step 5: Submit Within Deadline
Ensure the appeal is submitted within the payer’s specified timeframe to avoid forfeiting the right to appeal.

Step 6: Track and Follow Up
Use denial management tools like Adam to monitor the status of the appeal and follow up as necessary for timely resolution.

How To Prevent CO-287 Denials

Front-End Prevention

• Validate Provider Taxonomy Codes: Ensure providers are enrolled with the correct taxonomy codes in payer systems.
• Conduct Eligibility Checks: Verify patient and provider eligibility, including diagnosis and taxonomy code compatibility, before claim submission.

Billing Best Practices

• Use Claim Scrubbing Tools: Automate claim reviews to catch errors in diagnosis and taxonomy codes before submission.
• Standardize Workflows: Implement consistent processes for matching diagnosis codes to provider specialties during claim preparation.

Technology Solutions

• Leverage Intelligent Platforms: Use CombineHealth.ai’s Adam to identify potential mismatches and prevent denials proactively.
• Automate Documentation Reviews: Rachel (AI Appeals Manager) streamlines appeal preparation, improving accuracy and reducing turnaround time.

CombineHealth.ai’s advanced solutions provide automated eligibility verification and real-time claim scrubbing, minimizing CO-287 denials. When denials occur, Rachel simplifies the appeals process, enhancing success rates and cutting resolution times.

FAQs

Q1: What does CO-287 mean in medical billing?
CO-287 indicates that the diagnosis is inconsistent with the provider type, often due to a mismatch between taxonomy and diagnosis codes.

Q2: Can CO-287 denials be appealed?
Yes, CO-287 denials can be appealed by providing supporting documentation and addressing the mismatch in taxonomy and diagnosis codes.

Q3: How long do I have to appeal?
Appeal deadlines vary by payer but are often between 30 and 60 days from the denial date.

Q4: How can I prevent these denials?
Proactive measures like validating taxonomy codes, conducting eligibility checks, and using intelligent platforms like CombineHealth.ai can help prevent CO-287 denials. See our complete guide on denial prevention.