Denial Code Co 109

Denial Code CO 109

Most frequently, we receive this denial code CO 109 from Medicare insurance company. It means claim or service not covered by this payer or contractor, you must send the claim or service to the correct payer or contractor.

Medicare insurance will deny the claim with denial code CO 109 when the service is covered under an HMO policy for the service billed, but claims submitted to Medicare for reimbursement. So, when the service is covered by a Medicare advantage insurance, then claims should be submitted to them for reimbursement.

What is Medicare advantage Plan?

It also called as Medicare Part C and offered by private companies, and it is approved by Medicare. Medicare advantage plan covers all the services that original Medicare covers except Hospice care. Original Medicare covers the hospice care even if patient opted for Medicare advantage plan. Medicare advantage plan offer extra benefits such as dental care, eyeglasses, wellness programs and most of them also cover prescription drug coverage.

Medicare deny the claim with CO 109 along with the following remark Codes:

N418 – Misrouted Claim

N104 – This claim/service is not payable under our claim’s jurisdiction area.

It means that patient has move to a Medicare advantage insurance from original Medicare and claim should be submitted to Medicare advantage insurance for reimbursement.

Denial Code CO 109 Solution:

• When you get the denial code CO 109 with remark code N418 or N104, the very first step is to check the eligibility of Medicare insurance through web portal and find out the Medicare advantage insurance name at the time of service.
• Get the details either through Medicare advantage insurance card copy in the application or reach out the Medicare advantage insurance eligibility department for Member ID# to bill the claim.
• Update the Medicare advantage insurance information in the application and bill the claim for reimbursement.

Questions need to ask when you reach Medicare insurance claims department:

• May I know the claim received date and denial date.
• May I know the Medicare advantage insurance name?

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)