Reason Code: CO-B7

Error Description:

This provider was not certified/eligible to be paid for this procedure/service on this date of service.

Avoiding/Correcting This Error

There is an issue with the billing and/or rendering provider credentialing information per provider enrollment, provider information submitted on the claim and/or or the services provided are not allowed per the providers specialty/credentials.

This could reflect a number of possible issues. It is important to verify the information submitted on the claims and to verify the credentialing via PECOS.

The following scenarios would apply:

• The billing provider number contains something other than alpha or numeric characters.
• The billing provider PIN field is blank.
• Claim detail from date of service is prior to the billing provider's Medicare effective date if the Medicare effective date is present on the provider file.
• Claim detail from date of service is prior to the performing (detail) provider's Medicare effective date if the detail provider's Medicare effective date is present on the provider file.
• The services were performed prior to the provider’s certification date.
• Provider A/R 52 - ERP (EDUCATION RECOGNITION PROGRAM) certificate must be on file for codes G0108 and G0109 to be billed.
• A procedure code is not set up for the performing provider type and/or specialty reported.
• Certain radiology restrictions for X-rays billed by provider type 38 in the wrong state.
• Exception for NY State, which requires certification for nurse practitioners to perform assistant-at-surgery services. This does not apply to CT or any J6 or JK NE states.
• If the rendering provider NPI (REND-NPI) field and the rendering provider PIN (REND-PROV) field are both populated, but do not have a valid relationship.
• Specialty 69 with place of service 60 being billed.
• IDTF providers can only bill procedures that they submit on their initial/updated provider enrollment application. If not set up it will be denied.
• If provider has one of the below A/R codes on provider enrollment file:
  • A/R 31 = Provider retired
  • A/R 32 = Provider moved out of state
  • A/R 39 = Provider resigned (C.P.S. - Voluntary - Board of Registration - CMS)
  • A/R 38 = Provider Deceased
  • A/R 36 = Suspend - Social Security Administration (SSA) review
  • A/R 37 = Suspend - Pay Medicare non-assigned
  • A/R 42 = New group - pending Medicare B approval and profile transfer
  • A/R 43 = Group not approved for Medicare B reimbursement
  • A/R 46 = INACTIVE PROVIDER = Action Reason on PE file used when PE enrollment status is inactive, or provider is end-dated

  • A/R 72 = was created for the deactivation of those providers who have not billed Medicare for 12 consecutive months