Denial Code CO 22 – This care may be covered by another payer per coordination of benefits

Before going forward about the denial code CO 22 – This care may be covered by another payer per coordination of benefits, let us understand first what does Coordination of Benefits means.

What is COB in Medical Billing?

Coordination of Benefit is also called as COB. If patient has more than one payer, then the Coordination of Benefits rules determines and decides which will be the primary, then secondary and the tertiary insurance etc., to ensure no duplication of payments and paid by the correct payer respectively.

When patient is having with more than one health insurance policy, then it is patient responsibility to update all of his/her insurance policy information and the order of payment as which will be the primary, secondary and tertiary insurance. The main idea behind this is to ensure that the payment should not exceed more than the covered charges.

Whenever we are filing the claim to insurance company we have to make sure to submit the claim to primary insurance first, then the balance to the secondary and followed by tertiary insurance to avoid the denial CO 22 – This care may be covered by another payer per coordination of benefits from the insurance company.

When insurance company denies the claim as CO 22 – This care may be covered by another payer per coordination of benefits, the first important step is to check eligibility to determine which insurance is primary, which will be the secondary and tertiary etc., in order to submit the claim to the correct insurance respectively.

  • If we find the active primary insurance, then we have to first submit the claim to the primary insurance. Once we receive a payment from the primary insurance, then we need to submit the balance to secondary insurance along with the primary EOB.
  • Suppose if you find patient is having only one active payer at the time of service, but insurance company is denying the claim with the denial reason CO 22 – This care may be covered by another payer per coordination of benefits. Then we need to contact member, because member has to call insurance company and update the correct COB information in order process the claim.
  • Similarly if patient is having more than one payer, but both the payers have confusion as which is primary, secondary and tertiary etc., then insurance company denies the claim with the denial code CO 22 – This care may be covered by another payer per coordination of benefits. Even in this case we have to communicate with member to call the payer and update the correct COB information.

You can reach the insurance company claims department to check on this denial with the following questions:

Denial code CO 22 – This care may be covered by another payer, per co-ordination of benefits
1Claim received date
2Claim denied date
3Check with insurance company whether they are primary or secondary or tertiary
If PrimarySecondaryTertiary
4Send the claim back for reprocessingRequest representative to provide the Primary insurance details such as Name, id#, Contact#Request representative to provide the Secondary insurance details such as Name, id#, Contact#
5Claim number
6Cal reference number

 

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