Denial Code CO-112

Reconsideration request letter

Use this reconsideration letter as a starting point. Before sending, confirm the specific denial reason with the payer and that a written reconsideration is the correct workflow.

[Your Practice Letterhead]
[Date]

[Payer Name]
Claims Reconsideration Department
[Payer Address]

Re: Request for Reconsideration, Denial Code CO-112
Patient: [Patient Name]
Member ID: [Member ID]
Claim Number: [Claim Number]
Date of Service: [DOS]

To Whom It May Concern:

We are requesting reconsideration of the above claim, which was returned with denial code CO-112 (Service not furnished directly to the patient and/or not documented).

Please review the attached documentation. We are providing the materials below so that you can determine whether additional information is needed, whether the claim can be reprocessed on the current record, or whether the denial was correctly applied.

Supporting documentation attached:
• Original claim submission (CMS-1500 or UB-04)
• Provider documentation for the date of service
• Prior authorization reference, if applicable
• Member eligibility confirmation for the date of service

Please provide a determination within the applicable review period — typically 30 to 45 days for commercial payers and 60 to 120 days for Medicare redetermination. If additional information would help resolve this claim, please contact us at the number below.

Sincerely,
[Provider Name or Billing Manager]
[NPI / TIN]
[Contact Phone] · [Email]

---
This template is a starting point. The biller or provider is responsible for reviewing the specific claim, confirming that the billed services are supported by documentation, and customizing any clinical narrative before sending. Verify the current reconsideration/appeal address and timeframes in the payer's provider manual.

CO-112 FAQ