Healthcare Error Code
Healthcare Insurance / Medical Billing
Authorization / Medical Necessity

CO-26 | Expenses incurred before coverage

Industry
Healthcare
Canonical
/healthcare/error-codes/co-26/
Last Updated
Feb 25, 2026
Summary

This code indicates that the service was provided before insurance coverage became effective.

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What This Code Means

CO-26 is used when a payer determines that expenses were incurred outside the active coverage period. Coverage effective dates define when benefits apply. Services provided before coverage begins are typically not reimbursable. This is a coverage timing issue rather than a billing or documentation error. It does not reflect on service quality.

Where Users Usually See This Code

  • EOB statements
  • Remittance advice
  • Coverage eligibility summaries

Why This Code Appears

  • Service date precedes coverage effective date
  • Enrollment start date was after service
  • Coverage activation delays occurred

What Typically Happens Next

  • Payment is denied
  • Responsibility may shift to the patient
  • The claim is finalized

What This Code Is Not

  • It is not a coding error
  • It is not a contractual adjustment
  • It is not a temporary hold

Troubleshooting Checklist

  • Verify coverage effective dates
  • Review enrollment records
  • Confirm eligibility timelines

Notes And Edge Cases

Retroactive coverage changes may affect how this code appears. Some plans allow limited retroactive eligibility.

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