CO-96 denial: Non-covered charge
The payer says the service or charge is not a covered benefit under the patient's plan.
Common causes
- The plan excludes the service
- The service is covered only under certain conditions that were not met
- The wrong plan or benefit was checked at registration
How to fix it
- Read the remark code and check the patient's actual benefits
- If coverage should apply, appeal with the policy language and records
- If the service is excluded and you are in network, follow your contract for what the patient can be billed
How to prevent it
- Verify benefits for the specific service before it is done
- Where a service may be excluded, discuss cost with the patient first
Zenith billers and AR specialists work denials like this inside your practice-management system, and your practice stays the billing provider. See AR follow-up and medical billing.
Educational summary, not billing or legal advice. Payer rules and deadlines vary; always check the payer’s own policy and the remark code on your remittance.