CO19 denial code description and corrective action

This is a work related injury/illness, so liability of worker compensation.

This denial mostly occurs when a claim is billed to a commercial payer, but the injury or illness is actually related to worker’s compensation.
Sometimes, even if the illness is not work-related, using an incorrect diagnosis that indicates a work-related injury can also lead to this denial.

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 first and 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 and ask the representative to provide information about worker’s compensation, if available. If the representative has the worker’s compensation details, then obtain all the necessary information. If not, then check history and documents or contact patient for worker compensation details.
Enter the worker’s compensation information as the primary insurance and bill the claim to worker’s compensation.
Do not keep the commercial payer as secondary, except in the case of Medicare. If worker’s compensation leaves any amount as the patient’s responsibility, bill it to Medicare by updating the MSP code.
If the patient documents show that the illness is not related to worker’s compensation, consult the coding team to review the coding. There may be a chance that an incorrect diagnosis code was used, which indicated the illness as work-related and resulted in the denial. If that is the case, submit a corrected claim, and for Medicare, submit a new claim.