Denial Code (CO-22)

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What is Denial Code 22?

Denial Code 22 in medical billing refers to “This care may be covered by another payer per coordination of benefits (COB).” This denial occurs when the insurance payer determines that another insurer should be the primary payer, leading to claim rejection or a delay in reimbursement.

Common Causes of Denial Code 22

Several factors contribute to Denial Code 22, including:

  1. Incorrect Coordination of Benefits (COB) Information
    • The patient has multiple insurance plans, and the primary and secondary insurers are not correctly identified.
  2. Medicare or Medicaid is the Secondary Payer
    • Medicare or Medicaid must act as a secondary payer when the patient has other active coverage, such as employer insurance.
  3. Outdated or Incomplete Insurance Information
    • If the patient has new insurance and the billing system is not updated, the claim may be sent to the wrong payer.
  4. Workers’ Compensation or Auto Insurance Claims
    • If the medical services resulted from a work-related injury or auto accident, the claim may need to be submitted to the appropriate insurance first.
  5. Patient Fails to Disclose Multiple Insurance Plans
    • Patients may forget to report other active insurance coverage, leading to claim misrouting.
  6. Duplicate Coverage Issues
    • The patient may be covered under two policies (such as both parents’ insurance plans), and the primary payer is not clearly identified.

How to Fix Denial Code 22

1. Verify Patient’s Insurance Coverage

  • Check if the patient has multiple insurance policies.
  • Contact the patient or use an eligibility verification tool to determine which insurer should be primary.

2. Obtain and Update Coordination of Benefits (COB) Information

  • Request updated COB details from the insurance company.
  • Ensure the correct primary and secondary payers are recorded.

3. Resubmit the Claim to the Correct Payer

  • If the claim was sent to the secondary payer instead of the primary payer, correct the payer details and resubmit the claim.
  • If applicable, submit an Explanation of Benefits (EOB) from the primary insurer to the secondary insurer.

4. Submit an Appeal if Necessary

  • If the denial was issued in error, file an appeal with supporting documents, such as:
    • COB updates
    • EOB from the primary payer
    • A letter of explanation detailing the correct payer order

5. Contact the Insurance Payer for Further Assistance

  • Speak with the payer’s COB department to resolve discrepancies and confirm the correct payer sequence.

6. Educate the Patient on COB Rules

  • If the patient has dual coverage, educate them about how their plans coordinate benefits.
  • Request them to inform their insurers of any changes in coverage.

Preventing Future Denials Related to Code 22

To minimize the recurrence of Denial Code 22, follow these best practices:

  1. Verify Insurance Information During Every Visit
    • Check for multiple active insurance policies.
    • Update COB details in the patient’s records.
  2. Use Real-Time Eligibility Verification Tools
    • Implement electronic eligibility verification to check payer details instantly.
  3. Train Front Desk and Billing Staff on COB Policies
    • Educate staff on verifying primary and secondary coverage.
    • Ensure they update COB details before submitting claims.
  4. Request COB Confirmation from Insurers
    • Contact the primary and secondary payers to confirm the COB order before claim submission.
  5. Monitor and Track Denials Related to COB
    • Analyze denial trends to identify recurring COB issues.
    • Address issues proactively before claims are submitted.
  6. Implement an Automated COB Management System
    • Use billing software that tracks COB status and alerts billing teams to discrepancies.

Conclusion

Denial Code 22 is a common medical billing challenge, often arising due to incorrect payer order or outdated insurance details. By verifying COB details, educating patients, and implementing best practices for claim submission, healthcare providers can significantly reduce claim denials. Resolving and preventing Denial Code 22 ensures a smoother billing process and improved revenue cycle management. If your claim is denied due to this reason, take immediate corrective actions, resubmit the claim, and follow up with insurers to expedite reimbursement.

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