Quick Explanation
Denial code CO 27 indicates that the medical services were rendered after the patient's health insurance coverage had been officially terminated. Because the policy was inactive on the date of service, the payer is not responsible for reimbursement, and the claim is denied.
Common Causes for CO 27
Denials with code CO 27 typically happen for the following specific reasons:
- The patient's coverage was retroactively terminated by their employer or the insurer due to employment termination or non-payment of premiums.
- A failure to perform real-time eligibility (RTE) verification at the time of check-in, allowing an inactive policy to be billed.
- The patient transitioned to a new insurance plan or payer but failed to present their new insurance card at the time of the encounter.
- COBRA continuation coverage was elected but later retroactively canceled due to the patient's failure to make timely premium payments.
How to Prevent CO 27 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Perform automated real-time eligibility (RTE) checks on the exact day of service for every patient encounter, regardless of past history.
- Establish a pre-registration protocol that prompts patients to verify and upload their active insurance card prior to their appointment date.
- Require front-office staff to verbally confirm whether any employment or insurance policy changes have occurred since the last visit.
- Set up system alerts for services requiring prior authorization to re-verify plan active status immediately before the scheduled procedure.
Appeal Letter Template for CO 27
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: CO 27 - Multi-specialty denial code
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code CO 27: "Multi-specialty denial code".
We are appealing the denial under code CO 27 (Expenses incurred after coverage terminated) for the date of service [Date of Service]. Our records show that our billing department verified the patient's active eligibility on [Verification Date] with confirmation number [Confirmation Number] prior to rendering care. The provider acted in good faith based on the positive eligibility confirmation provided directly by your system. Because the termination of coverage was applied retroactively after verification was completed, we respectfully request that you honor this claim for payment under administrative exception rules, or provide the contact information for the correct coordinator of benefits or primary payer.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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