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CO-276 Denial Code: Prior Payer Denied, Also Not Covered

CO-276 means this secondary or tertiary payer won't cover services that were denied by the prior payer. The fastest path to payment is usually to resolve the primary denial itself, since the secondary is following that outcome.

Quick facts

Code
CO-276 (CARC 276)
Status
Active In use since November 1, 2015.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The usual group. The provider absorbs the amount unless the primary denial is overturned or the secondary reconsiders.
  • PR (Patient Responsibility): Used when the patient is responsible, for example because the primary denial reflected a patient-side issue such as a non-covered benefit. The patient may then be billed.
Official description
Services denied by the prior payer(s) are not covered by this payer.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-276 means

CARC 276 says services denied by the prior payer(s) are not covered by this payer. It appears on a secondary or tertiary remittance. The primary payer denied the service, and this payer won’t step in to cover it.

The key is the reason for the primary denial. If the primary denied for something you control, such as missing authorization, a coding error, missing information, or late filing, the secondary is effectively saying, “Fix it with the primary first.” If the primary denied because its plan simply doesn’t cover the service, the secondary may or may not have its own coverage, depending on its rules.

Common causes

  • Provider-side primary denials, such as missing authorization (CO-197), invalid information (CO-16), or timely filing (CO-29).
  • Primary medical necessity denials that the secondary adopts.
  • Secondary plan rules that exclude services the primary didn’t cover.
  • COB data showing a primary denial when the primary actually paid on a corrected claim that hasn’t been reported to the secondary.

How to fix it

  1. Pull the primary ERA and identify the denial reason for each line.
  2. Resolve correctable primary denials through a corrected claim (resubmission code 7 in box 22) or appeal with the primary.
  3. Resubmit to the secondary with the primary’s updated adjudication once it pays.
  4. Check the secondary’s own coverage if the primary denied the service as a non-covered benefit, and appeal to the secondary if its plan covers it.
  5. Bill the patient only for amounts assigned as PR.

How to prevent it

  • Meet the primary’s requirements first, such as authorizations and referrals, even when the secondary has different rules.
  • Work primary denials promptly so secondary claims can follow.
  • Send updated COB data after any primary reprocessing.
  • Track denial chains from primary to secondary. An ERA Analyzer can connect primary denials to the secondary denials they cause.

See eligibility and COB denials for more on how primary and secondary rules interact.

Remark codes that may appear with CO-276

  • N536 (We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us.): The payer isn't changing the prior payer's determination of patient responsibility, which you may collect.
  • N36 (Claim must meet primary payer's processing requirements before we can consider payment.): The claim must meet the primary payer's processing requirements before this payer can consider it.
  • PR-275 (Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group Code PR)): The prior payer's cost-sharing isn't covered, rather than its denied services.
  • OA-136 (Failure to follow prior payer's coverage rules. (Use only with Group Code OA)): Failure to follow the prior payer's coverage rules, such as its authorization requirements.
  • OA-23 (The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)): The prior payer's adjudication impact on a processed claim.
  • CO-196Deactivated (Claim/service denied based on prior payer's coverage determination.): Deactivated code for denials based on the prior payer's coverage determination.

CO-276 FAQ

Why does the secondary follow the primary's denial?

Many secondary plans won't pay for services the primary denied, especially when the denial was for a provider-side reason like missing authorization, timely filing, or a coding error. Their benefits coordinate with the primary's decision.

What should I do first after CO-276?

Look at why the primary denied the service. If it was fixable, such as a coding error or missing information, correct it with the primary. Once the primary pays or changes its decision, resubmit to the secondary.

Are there cases where the secondary should pay anyway?

Yes. If the primary denied because the service isn't a covered benefit under its plan, some secondary plans will consider it under their own benefits. Medicaid as secondary often has its own coverage rules. Check the secondary's policy and appeal if appropriate.

Can I bill the patient?

Only when the payers report PR or your agreement allows. Under CO, the provider absorbs the amount.