Denial Code CO 22

Denial Code CO 22 – This care may be covered by another payer as per coordination of Benefits.

Insurance company will deny the claim with denial code CO 22, when the services billed should be paid by the other payer as per COB. As per the insurance they are not the primary payer as per COB and claim should be billed to primary insurance first for reimbursing the claim.

Here initially patient plays an important role when updating insurance details with provider at the time of service. Patient has to make sure to update and order of the insurances which will pay (Primary, Secondary, tertiary and so on) in order to avoid the denial code CO 22.

It is also Billing team responsibility to check eligibility and make sure the claim billed to correct payer first for reimbursement.

Coordination of Benefits:

Coordination of Benefits is also known as COB. It is the rules which determines and designates which will be the primary payer, then secondary payer and then the tertiary payer for the patient, when the patient has more than one active payers at the time of service. This rule is implemented to ensure no duplication payments is made to the provider for the services rendered and also to ensure it is paid by the correct payer respectively (Primary, then secondary, then tertiary and so on).

Denial Code CO 22 resolution:

In this scenario there are three possibilities we may come across:

1. When patient is having other active primary insurance for the services rendered at the time of service, but the claims are submitted to other insurance.

Whenever claim denied with denial code CO 22, then the very first step is to check eligibility to determine primary insurance, secondary and tertiary for the patient. If we found the active primary payer, then update and bill to primary insurance. Once primary process the claim and paid, then we need to bill the balance to secondary payer along with primary EOB for reimbursement.

• Patient is having only one active insurance, but insurance still denied with CO 22.

After checking eligibility if you found patient is having only one insurance for the service rendered, but still payer denied the claim with denial code CO 22, then we need to reach patient. In this case patient has to call insurance and update the correct COB information in order to reimburse the claim.

• Patient is having more than one insurance, but payers have confusion as which is primary and then secondary.

Similarly, when patient is having more than one insurance. But both the insurance has confusion as which will be primary insurance and then secondary insurance. In this case also we need to reach out patient and make them to update the correct COB information with insurance company for reimbursement.

Questions need to be asked when you reach out representative:

• May I know the claim denied or pending date?
• May I know what information is required from patient?
• Have you sent a letter to patient?
• If yes, then ask how many letters were sent and when was the last letter sent to patient?
• Have you received any response from patient?
• If patient has responded with the required information, then request claim-rep to reprocess the claim
• If patient has not responded, then request claim-representative to send one more letter to patient.

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