CO 206 denial code
Claim adjustment reason code 206. Often reported as CO 206.
NPI missing
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 206 means
The claim was missing a required National Provider Identifier, so the payer could not process it as sent.
One or more NPIs the payer needs, such as billing, rendering, referring or ordering provider, was left blank on the claim.
This is a front-end data problem. Fill in the missing identifier and resubmit; the service itself was not judged on its merits.
Group codes seen with 206
On a remittance, 206 comes after a group code. These are the ones it is most often reported with:
- CO 206 (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 rendering or referring provider field was left blank.
- A new provider was added to the system without an NPI on file.
- A claim scrubber or form mapping dropped the NPI from the outgoing file.
What to do next
- Find which provider field is missing an NPI using any remark codes and the claim data.
- Add the correct NPI to the provider record in your billing system.
- Resubmit the claim with the NPI in the right loop or box.
Related codes
- 207 (reason code) NPI in an invalid format
- 208 (reason code) NPI does not match payer records
- 16 (reason code) Missing information or billing error
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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