CO22 denial code description and corrective action

• Coordination of benefits refers to the process used by insurance companies to determine the order (primary, secondary, tertiary) in which multiple insurance plans will pay for a patient’s healthcare services. When a patient is covered under more than one insurance policy, COB ensures that payments are coordinated properly.

• This denial mostly occurs when a patient has more than one insurance plan but has not updated their coordination of benefits (COB) with the insurance company.

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 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 the details of the primary payer, if available. If the representative has the information, obtain all the necessary details such as insurance name, policy number, payer ID, and effective period. Once confirmed, bill the claim to that insurance after verifying the eligibility and make current insurance as secondary.

  If the insurance information provided by the representative is not active on the DOS, request the representative to reprocess the claim since there is no active other insurance. Be sure to note the claim number, processed date, call reference number, and representative’s name, and follow up on the claim after the provided TAT.

  If the representative has no information about the primary insurance, check the supporting documents and member history to identify the primary payer. If no details are found, contact the member to obtain the primary insurance information, and then bill the claim to the primary insurance after verifying eligibility and make current insurance secondary.

• Sometimes both insurances deny the claim with the same COB reason. In such cases, contact the member and ask them to update their COB with the insurances and inform us once it is updated so the claim can be processed. If the member does not respond, then bill the claim to the patient.

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