Covered by another payor - CO 22 & 23 - Insurance denial

CO 22 Payment adjusted because this care may be covered by another payer per coordination of benefits.

Explanation :

• Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.

Solution:

This denial indicates the beneficiary has an insurance primary to Medicare on file.

• Contact the patient to determine if any change has occurred in their insurance status. You can also check through eligibility verification to determine if Medicare is the patient's primary or secondary insurance.

• Once this analysis is complete, update the insurance information on your files for all future claims.

• You may contact the Coordination of Benefits Contractor (COBC) and update the patient’s files by conducting a conference call with the patient.

Here are steps you can take to help avoid this denial in the future:

• Periodically, have your patient(s) help you determine if Medicare is the primary or secondary payer.

• Check your patient’s eligibility, including if Medicare is a secondary payer, via the IVR.

• If Medicare is secondary, the IVR will list the following MSP details:

1. Type of primary insurance

2. Effective and termination date for all valid Insurers for a current or previous date of service.

CO 23 Payment adjusted because charges have been paid by another payer. 

• Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer.

This denial is received when a service, which has been indicated as being purchased from another provider, is showing having already been paid to another provider elsewhere.

Posted in: COB denial