What is Denial Reason Code CO 22? How to Resolve it?

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What is Denial Reason Code CO 22? How to Resolve it?

 

Denial Code CO 22 – This care may be covered by another payer per coordination of benefits (COB).
Coordination of Benefits is also called as COB. If patient has more than one payer, then the Coordination of Benefits rules determines and decides which will be the primary, then secondary and the tertiary insurance etc., to ensure no duplication of payments and paid by the correct payer respectively.
CO (Contractual Obligation) 22 denial code related denials happen when the secondary payment isn’t fulfilled without information from the first.

The most common reasons for such denials are:
• Patient is insured by another program other than Medicare
• Patient’s COB itself is not up to the mark

When insurance company denies the claim as Code CO 22, the first important step is to check eligibility to determine which insurance is primary, which will be the secondary and tertiary etc., in order to submit the claim to the correct insurance respectively.
• If we find the active primary insurance, then we have to first submit the claim to the primary insurance. Once we receive a payment from the primary insurance, then we need to submit the balance to secondary insurance along with the primary EOB.
• Suppose if you find patient is having only one active payer at the time of service, but insurance company is denying the claim with the denial reason Code CO 22. Then we need to contact member, because member has to call insurance company and update the correct COB information in order process the claim.
• Similarly if patient is having more than one Payer, but both the payers have confusion as which is primary, secondary and tertiary etc., then insurance company denies the claim with the denial Code CO 22.
• Even in this case we have to communicate with member to call the payer and update the correct COB information.

You can reach the insurance company claims department to check on this denial with the following questions:
1. Claim received date
2. Claim denied date
3. Check with insurance company whether they are primary or secondary or tertiary
If Primary
Send the claim back for reprocessing
If Secondary
Request representative to provide the Primary insurance details such as Name, id#, Contact#
If Tertiary
Request representative to provide the Secondary insurance details such as Name, id#, Contact#
4. Claim number
5. Call reference number

How To Avoid Denials CO 22
Providers must know beforehand where to file the initial claim:
• Traditional Medicare?
• An employer sponsored group insurance plan?
• Medicare Advantage plan?

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