What is a Denial Code CO-24? Covered under Capitation Agreement?

Denial Code CO-24: Charges are covered under a capitation agreement or managed care plan.

If Beneficiary enrolled in Medicare advantage plan or managed care plan, but claims are submitted to Medicare insurance instead of submitting it to Medicare Advantage plan, then the claims will be denied as CO-24 – Charges are covered under a capitation agreement or managed care plan.
Medicare Advantage Plan also called as Medicare Part C. This Medicare advantage plans are offered by private insurance companies, which will be approved by Medicare to cover Medicare Part A and Medicare Part B services except hospice cares. These private insurance companies must follow the rules set by Original Medicare.
Original Medicare covers the Hospice care even if you have Medicare Advantage Plans. So it means Medicare advantage must cover all the medical services that original Medicare covers except hospice care. Many Medicare Advantage Plans includes drug coverage and also offers extra benefits like dental, vision care or wellness programs.

Follow the below instructions to get rid of the denial Code CO-24.

• Before submitting any claims to Medicare, first check Medicare eligibility to see if patient benefits are covered under Managed Care plan. If you come across that the services are covered under Managed care plans at the time of service.
• Then the next step is to obtain the member ID of that particular private insurance from Medicare or Patient.
• Finally, claims must be submitted to that beneficiary managed care plan private insurance in order to get rid of the denial CO-24– Charges are covered under a capitation agreement or managed care plan.

If you have already received the above denial from Medicare, then you can also find out the particular managed care insurance by reaching the Medicare claims department with the following questions:

1. Claim received date
2. Claim denied date
3. May I know the Managed care insurance Name, id#, Contact#( if not available in the software application)
4. Claim Number
5. Call reference Number

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