Insurance policies are already quite complex. To make matters worse, around 43 million people (mostly senior citizens) have more than one insurance plan, according to the United States Census Bureau.
Due to this, many healthcare professionals fail to identify their patients’ primary and secondary insurance coverages. As a result, they submit claims to the wrong payer and face the CO 22 denial code.
If you are also experiencing this issue, maintain the financial health of your practice by learning everything about denial code 22.
CO 22 Denial Code – Description
The CO 22 denial code specifies that a particular insurance company is not responsible for the payment of a specific service. In simple terms, it means that the healthcare provider has submitted the medical claim to the wrong insurance company.
The stats show that it is quite common for US citizens to have multiple insurance plans. But how are healthcare providers compensated in this scenario? Insurance companies use the Coordination of Benefits (COB) process to determine the payment order.
Let us simplify things with an example.
A patient with two insurance policies has a $10,000 surgery. According to the Coordination of Benefits (COB), Company A is the primary payer, covering $6,500. Meanwhile, Company B is the secondary payer responsible for $3,500 for this procedure.
However, the healthcare provider mistakenly submits the medical claim to Company B. As a result, the payer denies the medical claim with a CO 22 denial code.
It is clear that while multiple insurance coverages allow patients to save more money on medical services, they can be quite burdensome for healthcare providers. Most professionals don’t have time to verify their patients’ information to identify the correct payer. As a result, CO 22 is one of the most common denial codes.
Common Causes of CO 22 Denial Code
The working environment in the healthcare industry is already insanely stressful and unpredictable. The additional burden of administrative tasks and medical billing negatively impacts the quality of patient care. Therefore, billing and coding errors are a common challenge in this industry, leading to frequent claim denials.
While CO 22 is one of the top 10 denial codes in medical billing, you can avoid it by reviewing your patient’s coverage. Let’s decode this denial code.
Coordination of Benefits (COB) Confusion
The CO 22 denial code primarily occurs due to the confusion between primary and secondary insurance coverages. Healthcare providers often submit medical claims to the wrong company. As a result, insurance companies refuse to compensate them with this denial code.
This COB confusion can also result in partial reimbursements due to the lack of coordination between the primary and secondary payers.
Incorrect Patient Information
Another reason for receiving the CO 22 denial code is incorrect information in the medical claim. The insurance companies deny medical claims with inaccurate patient’s name, DOB (date of birth), insurance policy number, or any other relevant detail.
Late Submission to One of the Payers
Denial code 22 also occurs when claims are not submitted on time. For example, the primary insurance company already processed the medical claim, but you failed to meet the secondary payer’s timeframe.
Updated Coverage
You can also receive a CO 22 denial code if one of the patient’s coverage has changed or expired. This common error usually occurs when the patient fails to renew the policy.
Missing EOB (Explanation of Benefits) Document
Primary payers provide an Explanation of Benefits document after processing your claim. If you fail to attach this receipt with your secondary medical claim, the company will deny it with a denial code CO 22.
Preventive Strategies for Denial Code CO 22
You can avoid this denial code by taking the following preventive steps.
Review Your Patients’ Insurance Coverage
Make it a habit to review your patients’ insurance information, including covered services, number of payers, and maximum allowable amount, before submitting any medical claim. Verify and update all the important details to ensure accurate submission.
Verify Coordination of Benefits (COB)
Next, check the Coordination of Benefits (COB) document to identify the primary and secondary payers (payment order). Make sure to submit the medical claim to the correct insurance company in the right order.
Attach EOB Document
Don’t forget to attach the EOB receipt from the primary insurer while submitting a secondary claim. This Explanation of Benefits (EOB) helps to reduce the denial rates of secondary claim submissions.
It highlights essential details like the costs of covered medical services, the amount covered by the primary payer, and how much the patient owes to the healthcare provider.
Submit Claims on Time
You must also follow the timeframes of both payers. Go through their policies and submit the claim within their specified timeline to avoid denial code 22.
Train Your Staff
Your billing staff should know how to handle multiple insurance policies. Arrange regular training sessions to increase their knowledge of common denial codes, including CO 22.
Keep an Eye on the Changes
Lastly, stay updated with your patients’ insurance policies. Keep track of the changing coverage and payer’s guidelines to avoid this denial code.
CO 22 Denial Code – Management & Resolution
Denial code 22 can be quite persistent if you don’t know how to verify the primary and secondary payers.
However, you should promptly resolve this payment issue to maintain the financial health of your practice. Here is how you can efficiently address the CO 22 denial code.
Verify the Denial Reason
The key to solving this code is to understand its root cause. Check your denied claim to see why your request for reimbursement was rejected.
Review the Patient’s Insurance Coverage
Go through your patient’s insurance coverage to verify all the important information, including their details and the insurance companies. Verify the primary and secondary payers and check if you mistook them for one other.
Identify the Primary Payer
Identify the right primary insurance company and contact them to see if they require any additional documentation.
Submit the Medical Claim to the Correct Insurer
Next, submit the claim to the right provider. If your primary claim has already been processed, obtain the Explanation of Benefits (EOB) receipt and submit the claim to the secondary payer.
Follow Up
Track the progress of the submitted claim to obtain timely reimbursement. Stay in touch with the insurance company until you receive the payment and document everything.
Appeal (if Necessary)
If the payers denied your claim by mistake, appeal their decision with proper documentation. Go to their website or contact them to familiarize yourself with the process of filing an appeal and submit a formal request to the insurance company to overturn their decision.
Bottom Line
To sum up, denial code 22 occurs when the payer declares that another insurance company already processed a medical claim. This denial code is quite common. In fact, it is one of the top 10 most commonly used reasons by insurance companies to reject your claim.
However, you can avoid denial code CO 22 by reviewing your patients’ insurance coverage and identifying the primary and secondary payers. You can also resolve it using the management techniques listed above. But if you still feel that the entire process is complicated and time-consuming, seek professional denial management services from a reputable medical billing firm and let them handle everything.
