CO151 denial code description and corrective action

• This denial occurs when a procedure is billed more times than allowed under the reimbursement guidelines.

Actions

• First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.

• The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.

• Call the insurance company to confirm the reimbursement guidelines for this procedure. These guidelines define the limitation on the number of units that can be billed within a certain time period (e.g., once per day, once per year, etc.). After confirming, verify in your system whether the claim was billed according to the guidelines or if it exceeded the allowable limits.

  If the claim is found to have been billed according to the guidelines, ask the representative to reprocess the claim. Be sure to document the claim number, representative’s name, and call reference number, and follow up on the claim after the provided turnaround time (TAT).

  If the procedure has already been paid up to the maximum allowed according to the insurance guidelines, but no such claim is found in our system, obtain the information from the representative along with the provider details on the claim. It is possible that the charge was not posted in our system or that the claim was billed by another provider. If the procedure and provider information provided by the representative match the notes, then the denial is considered correct. In such cases, contact the client to discuss and proceed as per their direction. The client may request to submit an appeal or write off the charge.

  If the procedure has already been paid up to the maximum allowed according to the guidelines and is also present in our system, follow the practice SOPs and proceed accordingly.

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