Denial Code CO-109: Service Not Covered by this Payer

Denial code CO-109: Claim or Service not covered by this payer or contractor, you may send it to another payer or covered by another payer.

If denial code CO-109 occurs in any claims that mean the patient has another payer or insurance and the patient did not update info that which is primary ins and which is secondary ins. Mostly due to this reason denial CO-109 or covered by another payer denial comes.

• When the service is covered under an HMO policy for the date of service billed
• If patient enrolled in SNF at the time of DME service billed
• When claim submitted to different region (Other than the beneficiary lives in).

The below steps we have to follow to handle this denial

Covered under HMO Policy:

1. Check eligibility and find out under which HMO policy the claim is covered for the service billed.
2. Update and submit the claim to correct payer or contractor.

When DME claim gets denied as CO-109: Claim or Service not covered by this payer or contractor, you must send the claim or service to the correct payer or contractor. We need to review the remarks code reasons to resolve the issue.

Remark code MA101:

1. First check to see if patient enrolled in Skilled Nursing Facility at the time of Date of Service billed.
2. If found patient enrolled in SNF at the time of DME service billed, then the next step is to write off.
3. If suppose beneficiary not enrolled at the time DME service provided, then reopen the claim or else send re-determination along with supporting documents.

Remark code N104:

1. First check to see whether the DME claim submitted to wrong region, by verifying the address of the beneficiary.
2. Update the correct address and submit the claim to the corresponding region in order process the claim correctly.

You can call the claims department to check with the following questions for the denial code CO-109: Claim or Service not covered by this payer or contractor, you must send the claim or service to the correct payer or contractor:

1. Claim received Date
2. Claim Denial Date
3. If claim denied as Covered under HMO Policy.
   May I know the HMO insurance Name, Id#, contact#, Mailing address?
4. If Patient enrolled in Skilled Nursing Facility.
   May I know the SNF Name, admission and discharge date?
5. If Claim submitted to wrong region.
   Check application or ID card to confirm and bill to the correct region (Confirm the same with representative).
6. Claim# and Cal Reference#

Learn More…

Important Steps to Follow in Medical Billing Process

Four Ways Providers Can Prevent Denials & Work More Seamlessly with Payers