How do I resolve a CO-11+N267 denial?

Validate diagnosis-to-procedure relationship in the original claim: Review whether the submitted diagnosis code(s) clinically support the billed procedure code; consult coding guidelines and LCD/NCD policies to determine the correct diagnosis or if a different procedure code is warranted Obtain and verify complete ordering provider secondary identifier: Confirm the ordering provider's NPI Type 2, state license number, UPIN, or other required secondary identifier is accurate and matches payer enrollment records; update internal credentialing data if necessary Submit corrected claim with accurate diagnosis-procedure pairing and complete ordering provider identifiers: File as a corrected claim (Frequency Code 7) with both the corrected diagnosis/procedure codes and the complete ordering provider secondary identifier in the appropriate claim segments

835 Denial Combination

CO-11+N267

Contractual Obligation · Service-Line Level Adjustment

Coding Error

What This Combination Means

This combination indicates the claim was denied due to a mismatch between the submitted diagnosis and procedure codes, compounded by missing or invalid ordering provider secondary identifier information (such as NPI, state license number, or other taxonomy). The payer requires both accurate diagnosis-to-procedure logic and complete ordering provider credentials to process the claim, and both deficiencies must be addressed before resubmission.

Financial Responsibility

provider writeoff

The provider must write off the denied amount under contractual obligation with the payer. The patient cannot be billed for this adjustment.

N/A

Appeal Success

7-14 days (corrected claim resubmission)

Avg. Resolution

Medium

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-11+N267 combination — not generic advice.

Not Appealable:This is a correctable coding and data submission error under contractual obligation, not a medical necessity or payment policy dispute.

1
Validate diagnosis-to-procedure relationship in the original claim
Review whether the submitted diagnosis code(s) clinically support the billed procedure code; consult coding guidelines and LCD/NCD policies to determine the correct diagnosis or if a different procedure code is warranted
2
Obtain and verify complete ordering provider secondary identifier
Confirm the ordering provider's NPI Type 2, state license number, UPIN, or other required secondary identifier is accurate and matches payer enrollment records; update internal credentialing data if necessary
3
Submit corrected claim with accurate diagnosis-procedure pairing and complete ordering provider identifiers
File as a corrected claim (Frequency Code 7) with both the corrected diagnosis/procedure codes and the complete ordering provider secondary identifier in the appropriate claim segments

Specialty Context

How CO-11+N267 typically presents across different practice types.

Dental

Medical

Common in radiology, lab, pathology, and durable medical equipment claims where an ordering provider is required and diagnosis codes must justify medical necessity for the ordered service or item

Behavioral Health

May occur on psychological testing or therapy services when diagnosis codes do not align with the procedure performed or when the ordering/referring psychiatrist or physician secondary credentials are incomplete

Individual Code References

View the standalone definition for each code in this combination.

CARC 11 RARC N267

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Synthesized from official definitions — not from training data

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