CO-95Contractual ObligationAuthorization
CO-95 Denial Code: Plan procedures not followed
Benefits adjusted because the plan's procedures were not followed.
Why CO-95 happens
- ●Referral, notification, or network steps skipped
- ●Out-of-network provider used without following plan process
How to fix a CO-95 denial
- 1
Identify which plan procedure was missed (remark code / payer call)
- 2
Appeal with evidence the process was followed, or request an exception
How to prevent it
Document plan-specific requirements in your verification workflow.
Drowning in CO-95 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.