CO49 denial code description and corrective action

Non covered services as it is a routine/ preventive exam or a diagnostic/ screening procedure done in conjunction with a routine/ preventive exam.

This denial occurs when a claim is billed with routine diagnosis codes (diagnosis code start with Z).
It can be resolved by changing routine diagnosis with another proper diagnosis code.

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.
Consult coding specialists to verify whether the diagnosis is appropriate.
If they provide the correct diagnosis code, submit a corrective claim with the updated diagnosis.
Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.
If the coding team confirms that the coding is accurate, the claim becomes the member’s responsibility, as the routine service is not covered under their plan.
In this case, we will attempt to obtain information about the secondary insurance, and if found, verify eligibility and bill the claim to the secondary payer.
If no other active insurance is present for this date of service, release the claim to the patient.
Sometimes the client requests that we submit an appeal before releasing the claim to the member; in such cases, proceed accordingly.
For submitting an appeal, we must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the appeal even after the timely filing limit has passed, so we should proceed according to their instructions.