What is denial code CO-22?
CO-22 means the payer believes another insurer should pay first under coordination of benefits. The claim has to go to the primary payer, or the payer's records have to be corrected.
Remittance advice, claim line
- Patient
- Riley Sample, age 9
- Billed to
- Mother's plan, birthday August 2
- Also covered by
- Father's plan, birthday March 11
| Service | Billed | Paid | Adjustment |
|---|---|---|---|
| 99393 Well child visit | $175.00 | $0.00 | CO-22 $175.00 |
- Under the birthday rule, the parent whose birthday comes first in the year is primary. That's the father's plan, so bill it first, then send this plan the secondary claim.
Reason code 22 reads: This care may be covered by another payer per coordination of benefits.
Why it happens
- The patient has two plans and the claim went to the secondary one first.
- The payer’s records show other coverage that has actually ended.
- The patient hasn’t answered the payer’s coordination of benefits questionnaire, so the payer pends or denies until they do.
How to resolve it
Confirm the order of coverage using coordination of benefits rules. If another plan is primary, bill it, then send a secondary claim here with the primary’s payment. If the payer’s records are wrong, the patient usually has to call and update them, and the claim is reprocessed after that.
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