Coverage Not in Effect on Date of Service (Termination)
The payer's records show the patient's coverage ended before (CO-27) or had not started as of (CO-26) the date of service billed.
Guided troubleshooter available for this denial
Answer a few questions to reach the correct disposition. No patient or claim identifiers requested.
In plain language
The payer's records show the patient's coverage ended before (CO-27) or had not started as of (CO-26) the date of service billed.
Start here
Verify coverage dates via real-time eligibility and payer portal for the specific date of service.
Who resolves it
Registration/Patient Access, Billing
Who prevents it
Registration/Patient Access — eligibility verification timed close to the date of service, including for recurring/scheduled series of visits.
How to resolve this denial, step by step
- 1
Verify coverage dates via real-time eligibility and payer portal for the specific date of service.
- 2
Compare to claim submission.
- 3
If payer data conflicts with proof of active coverage, contact payer with documentation (enrollment confirmation, COBRA election, retro-eligibility letter).
- 4
If coverage genuinely lapsed, identify the correct payer (new plan, Medicaid retro- eligibility, self-pay) and rebill accordingly.
- 5
Document the eligibility timeline.
- 6
Escalate if a Medicaid or Medicare Advantage retroactive disenrollment/enrollment issue is involved.
Then choose the correct disposition
Eligibility correction
most common resolution.
Reconsideration/appeal
appropriate only if the provider has documentation proving the payer's termination date is factually incorrect.
Patient responsibility
only after confirming no other payer is responsible and regulatory/contractual rules permit billing the patient.
Stop and escalate when
- Conflicting coverage-date information between payer systems; suspected retroactive Medicaid/MA disenrollment (see CMS timely filing exception categories, cross-reference D11); patient disputes termination.
What Needs to Be Corrected
- Claim correction: If the plan was actually active and the payer's termination date is wrong, request payer correction/reprocessing with proof of active coverage (e.g., enrollment letter).
- Upstream correction: If coverage truly ended before the date of service, the account moves to secondary payer billing, self-pay, or the retro-eligibility/COBRA process — not a claim data fix.
Do Not Do This
- Do not bill the patient automatically without confirming no secondary coverage or retroactive eligibility applies.
- Do not change the date of service to fall inside a coverage window.