CO-78Contractual ObligationContractual
CO-78 Denial Code: Non-covered days / room charge adjustment
Institutional adjustment removing payment for non-covered days or room-rate differences (e.g., private room upgrades without medical necessity).
Why CO-78 happens
- ●Days beyond covered benefit or leave-of-absence days billed
- ●Private room billed where semi-private was the covered level
How to fix a CO-78 denial
- 1
Verify covered-day counts against the payer's benefit period records
- 2
If medical necessity supported the room level, appeal with documentation
How to prevent it
Utilization review should confirm covered days before final billing.
Drowning in CO-78 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.