CO97 denial code description and corrective action

• This denial occur when insurance considered a service as a pert of other service so denied as benefit for this service has already been adjudicated with another service.

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.

• Call to insurance and get proper information of the denied procedure and also the informaton of procedure to which it is bundled. Also if we have paid claim in member's history with same coding then we ask rep to reprocess the claim. Must note the rep name, claim number and call ref number and follow back claim after TAT provided.

• Share this claim to coding team to check if claim could be reimbursed by updating some modifier. We can also use relaiable websites to check NCCI edit either these services could be billed together or not and if yes either they required modifier or not. It also provide most suitable modifier to override.

• If the services can be billed together and a modifier is identified either through reliable websites or the coding team, submit a corrective claim with the required modification.

• Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.

• If the services cannot be billed together according to NCCI edits, then the charges should be written off.

• If the coding team confirms that the coding is correct and the services can be billed together, then either contact the insurance to request reprocessing of the claim or proceed with submitting an appeal.

• For submitting an appeal or corrective claim, 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 or corrective claim even after the timely filing limit has passed, so we should proceed according to their instructions.

Description