CO 183 denial code
Claim adjustment reason code 183. Often reported as CO 183.
Referring provider not eligible to refer
Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated .
What 183 means
The payer will not pay because the provider listed as referring was not eligible to refer this service.
The referring provider on the claim is not allowed to refer for this service under the payer's rules. Common reasons are that the provider is not enrolled with the payer or is not a type that can refer for it.
The remittance may include a policy reference. Check the referring provider's name and NPI on the claim first.
Group codes seen with 183
On a remittance, 183 comes after a group code. These are the ones it is most often reported with:
- CO 183 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.
The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.
Common causes
- The referring provider is not enrolled with the payer.
- The referring provider's type cannot refer for this service.
- The wrong provider or NPI was entered as referring.
What to do next
- Check the referring provider's name and NPI on the claim.
- Confirm with the payer that the referring provider is enrolled and eligible.
- Correct and resubmit, or get a referral from an eligible provider.
Related codes
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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