CO-27 Denial Code: Expenses Incurred After Coverage Terminated
The payer's eligibility records show the member's coverage terminated before the service was provided. This is common after job changes, at the start of a month or plan year, and after Medicaid redeterminations. Coverage can also be terminated retroactively, which is why a claim can deny even when eligibility looked active at the visit.
Also appears as PR-27. The group code changes who is responsible, not the reason.
CARC 27 means the patient's coverage with this payer had ended before the date of service. Confirm the termination date, find out whether the patient has new coverage, and bill the right payer before timely filing runs out.
Common causes of CO-27.
- Patient changed jobs or plans and did not provide new insurance
- Eligibility was not re-verified at the visit
- Medicaid or marketplace coverage lapsed or was redetermined
- Retroactive termination by the employer or plan
How to work a CO-27 denial.
The order matters: confirm the facts before deciding between a corrected claim, a reconsideration, or an adjustment.
- 1Verify eligibility for the exact date of service and note the termination date.
- 2Contact the patient for new coverage information and verify it.
- 3Bill the correct payer promptly and track timely filing from the date of service.
- 4If you have a record that coverage was active on the date of service, request reconsideration with that evidence.
- 5If no coverage existed, follow your financial policy and payer contract rules for patient billing.
How to keep CO-27 from coming back.
- Run eligibility before every appointment, not only at intake
- Re-verify recurring patients at the start of each month and plan year
- Scan insurance cards at every visit and compare to what is on file
Fixing this at the source usually sits with eligibility verification →
Questions about CO-27.
Denials that often travel with this one.
CO-31: Patient Cannot Be Identified as Insured
CO-31 means the payer cannot match the patient to a member on its files. How to fix member ID, name, and date of birth mismatches and resubmit the claim.
Read about CO-31 →CO-22: Care May Be Covered by Another Payer
CO-22 (often OA-22) means the payer believes another plan is primary under coordination of benefits. How to confirm coverage order and get the claim paid.
Read about CO-22 →CO-109: Claim Not Covered by This Payer
CO-109 means the claim was sent to the wrong payer or contractor. How to identify the correct payer, including carve-outs and Medicare Advantage, and rebill.
Read about CO-109 →Add a Dedicated Denial Specialist
RCM Staff places trained denial management specialists inside your EHR and clearinghouse to work the queue, correct and appeal claims, and track root causes by payer.
Kevin Jamito has 18+ years of U.S. healthcare revenue cycle management experience across billing, coding, practice management, and offshore RCM operations. He founded RCM Staff to give U.S. healthcare teams dedicated Philippines-based specialists who work inside their existing systems.