When dealing with medical billing and insurance claims, encountering a denial can be frustrating and confusing. One commonly misunderstood reason for claim denials is the CO-22 denial code. Understanding what this code means and how to address it can save time, reduce rework, and improve the overall efficiency of your revenue cycle.
What Is the CO-22 Denial Code?
The CO-22 denial code stands for “Coordination of Benefits The patient has other insurance as primary.” It is used when a claim is submitted to the wrong insurance as the primary payer. In simpler terms, the insurance company that received the claim has determined that they are not the first (primary) to pay for the patient’s healthcare service; another insurance should be billed first.
This is part of a process called Coordination of Benefits (COB), which is used when a patient has multiple health insurance policies. The goal of COB is to ensure that claims are paid without duplication of benefits. The insurance companies work together to determine which one pays first, second, and so on.
Common Scenarios That Trigger CO-22 Denials
Several situations can lead to a CO-22 denial code. Some of the most common include:
- Patient Has Multiple Insurances: For example, a child may be covered under both parents’ health plans. The primary insurance is typically determined by the “birthday rule” whichever parent’s birthday comes first in the calendar year.
- Medicare and Group Insurance: A Medicare beneficiary who is still working and has employer coverage may need their employer plan to be billed first, depending on the size of the employer.
- Recent Insurance Changes: If the patient recently changed jobs or added a secondary plan, their primary insurance may have changed, and the billing provider may not have the most updated information.
- Incorrect or Missing COB Information: Sometimes, the patient hasn’t informed the insurance company about their other coverage, or the insurance hasn’t updated the patient’s file.
How to Resolve a CO-22 Denial Code
Resolving a CO-22 denial code involves verifying and correcting the insurance order. Here’s a step-by-step guide:
1. Contact the Patient
Reach out to the patient to confirm whether they have multiple insurance plans and to gather details such as:
- Names of insurance companies
- Policy numbers
- Effective dates
- Whether any recent changes have occurred
2. Verify Primary and Secondary Insurance
Use online eligibility tools or call the insurance companies to determine the correct order of benefits. Insurance plans follow specific rules for establishing primacy, such as:
- Birthday rule for dependents
- Employment status
- COB rules for Medicare and commercial plans
3. Update the Patient’s Insurance Information
Make sure your practice management system or electronic health record (EHR) is updated with accurate and current insurance information for the patient, as this is a critical step supported by professional medical billing and credentialing services to ensure smooth claims processing and fewer denials.
4. Resubmit the Claim
Once the correct primary payer is identified and COB is confirmed, resubmit the claim to the appropriate insurance company.
5. File with the Secondary Insurance (If Applicable)
After receiving payment or an Explanation of Benefits (EOB) from the primary insurer, file the claim with the secondary insurance along with a copy of the EOB to ensure proper processing.
Best Practices to Prevent CO-22 Denials
Preventing a CO-22 denial code is all about good data collection and verification. Here are some tips to minimize your risk:
- Collect Complete Insurance Information at Every Visit: Don’t assume coverage is unchanged. Ask for insurance cards and verify them every time.
- Train Front Desk Staff: Make sure staff are trained to ask the right questions about other insurance coverage.
- Use Real-Time Eligibility Tools: These tools can identify multiple coverages and flag potential COB issues before claims are submitted.
- Encourage Patients to Notify Insurers of Other Coverage: If patients fail to report dual coverage, it can lead to unnecessary delays and denials.
Summary
The CO-22 denial code is a common issue that can significantly delay claim payments if not handled correctly. Whether submitting routine services like CPT Code 99391 or more complex procedures, understanding what it means that another insurance is primary and taking proactive steps to gather and verify insurance information can help healthcare providers streamline their billing processes and reduce the number of denials.
Always remember, accurate coordination of benefits is a shared responsibility between the provider, the patient, and the insurance companies. With the right systems and communication in place, CO-22 denials can be minimized or avoided altogether.