CO26 denial code description and corrective action

• This denial occur when the date of service lies before the coverage start date of insurance.

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 and discuss the denial with the representative. If the policy is found to be active on the DOS, request the representative to reprocess the claim. Be sure to note the claim number, representative’s name, and call reference number, and then follow up on the claim after the provided TAT.

• If the DOS is earlier than the coverage start date, ask the representative to check their records to see if there was any active policy on the DOS. If a policy is found, resubmit the claim with the new policy ID after verifying eligibility.

  If no active policy is found, review the patient’s history and documents, check the portal, or contact the member to obtain the active insurance on the DOS. If active insurance is found, then resubmit the claim with that insurance after verifying eligibility.

• If there is no active insurance on the DOS, then bill the claim to the patient.

Description