What does CO-252 mean?
CARC code 252 means the payer needs additional documentation to process your claim. This is a straightforward denial to resolve — simply submit the requested documentation. Check the RARC code for specifics on what is needed (clinical notes, treatment plan, operative report, etc.). Attach the documentation to a corrected claim or submit it through the payer's document submission portal. This has a high overturn rate of approximately 85% because providing the missing documentation usually resolves the issue immediately.
How to appeal CO-252
Check the RARC code
The RARC (Remittance Advice Remark Code) on your ERA provides specific details about why the claim was denied. This tells you exactly what needs to be fixed.
Correct the identified issue
Fix the specific billing or coding error identified. Verify the correction against payer guidelines before resubmitting.
Resubmit the corrected claim
Resubmit with the appropriate frequency code (7 for replacement, 8 for void/resubmit) along with the corrected information.
Key notes for behavioral health
Missing documentation. Submit requested records. High overturn when docs are provided.
Related denial codes
Procedure code inconsistent with modifier used or required modifier missing
Diagnosis inconsistent with the procedure
Claim lacks information or has submission/billing error(s)
Benefit included in payment for another service
Procedure/modifier combination not compatible with another already adjudicated