How do I resolve a CO-226+N460 denial?

Retrieve the discharge summary that was originally submitted with the claim: Compare it against the payer's specific discharge summary requirements to identify what elements are incomplete or invalid Obtain a complete and valid discharge summary from the discharging provider or facility: Ensure all required components are present: admission/discharge dates, diagnoses, procedures performed, discharge disposition, medications, follow-up instructions, and physician signature Submit a corrected claim with the complete discharge summary attached or file a formal appeal with the corrected documentation: Include a cover letter explaining that the complete discharge summary is now provided and reference the specific elements that address the N460 deficiency

835 Denial Combination

CO-226+N460

Contractual Obligation · Claim-Level Adjustment

Missing Information

What This Combination Means

The claim was denied because the discharge summary submitted was either incomplete or invalid, and the payer considers this a provider obligation under contract terms. The specific deficiency is in the discharge summary documentation that was either missing required elements or contained errors that prevented claim adjudication.

Financial Responsibility

provider writeoff

The provider must write off the denied amount as a contractual obligation. The patient cannot be billed for this adjustment because the denial stems from the provider's failure to submit complete or valid discharge summary documentation.

75%

Appeal Success

30-60 days (appeal with documentation)

Avg. Resolution

Hard

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-226+N460 combination — not generic advice.

Appealable:Appealable if the discharge summary was actually complete and valid, or if a corrected/complete discharge summary can now be provided to satisfy the payer's documentation requirements.

1
Retrieve the discharge summary that was originally submitted with the claim
Compare it against the payer's specific discharge summary requirements to identify what elements are incomplete or invalid
2
Obtain a complete and valid discharge summary from the discharging provider or facility
Ensure all required components are present: admission/discharge dates, diagnoses, procedures performed, discharge disposition, medications, follow-up instructions, and physician signature
3
Submit a corrected claim with the complete discharge summary attached or file a formal appeal with the corrected documentation
Include a cover letter explaining that the complete discharge summary is now provided and reference the specific elements that address the N460 deficiency

Specialty Context

How CO-226+N460 typically presents across different practice types.

Dental

Medical

Common for inpatient facility claims, observation stays, skilled nursing facility admissions, and inpatient rehabilitation where discharge summaries are mandatory documentation for payment

Behavioral Health

Frequently occurs with inpatient psychiatric admissions and residential treatment discharges where comprehensive discharge summaries including treatment plan outcomes and aftercare recommendations are required

Individual Code References

View the standalone definition for each code in this combination.

CARC 226 RARC N460

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Synthesized from official definitions — not from training data

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