CO-22 Denial Code: What It Means for PT Clinics

What is Denial Code CO-22?

Denial Code CO-22 indicates that a claim has been denied because another insurance provider is potentially responsible for covering the service under the coordination of benefits. This situation arises when patients have multiple insurance policies, prompting the primary insurance company to defer payment to the secondary provider.

Understanding Denial Code CO-22 is crucial for medical billing professionals, particularly in physical therapy clinics. This code highlights the importance of coordination of benefits (COB), ensuring that claims are submitted correctly based on the patient’s insurance coverage. Proper management of CO-22 denials can enhance revenue cycle efficiency and reduce delays in payment.

Example of a Claim Denied with CO-22

For instance, consider a patient who receives physical therapy services and has both Medicare and a private insurance plan. If Medicare denies the claim stating that the private insurance should cover the service first, the billing team would receive a CO-22 denial code, indicating the need to pursue the secondary insurance for payment.

Common Reasons for CO-22 Denials 

Claims are denied under Denial Code CO-22 for several reasons related to coordination of benefits. Here are some common causes:

• Multiple Insurance Policies: When a patient holds more than one insurance policy, the primary insurance may deny the claim, indicating that another payer should cover the costs first.

• Incorrect Order of Benefits: If the billing staff does not determine the correct primary and secondary insurance order, it can lead to a CO-22 denial when claims are submitted to the wrong insurer.

• Lack of Coordination: Inadequate communication between insurance providers can result in confusion over which plan is responsible for the coverage, causing denials under this code.

Understanding these reasons can help clinics avoid future denials and improve their billing practices.

How to Resolve Denial Code CO-22?

Resolving Denial Code CO-22 involves a systematic approach to ensure proper coverage under the appropriate insurance plan. Follow these steps:

Step 1: Review the Denial Notice

Begin by examining the denial notice to understand why the claim was rejected. Look for details on the insurance policies involved and the reason for the denial.

Step 2: Identify Insurance Coverage

Confirm whether the patient has multiple insurance policies. If so, determine the primary and secondary policies based on coordination of benefits.

Step 3: Contact the Insurers

Reach out to both the primary and secondary insurers to clarify coverage responsibilities. This helps to ensure that claims are submitted to the correct payer.

Step 4: Resubmit the Claim

After confirming the appropriate insurance, resubmit the claim with accurate billing information, ensuring that all necessary details are included to facilitate proper processing.

Step 5: Follow Up

After resubmission, follow up to verify the status of the claim. This ensures that any additional requirements are met and helps expedite the resolution process.

By following these steps, PT clinics can effectively address CO-22 denials and improve their revenue cycle management.

How SPRY Helps Prevent CO-22 Denials

SPRY provides robust solutions tailored to help PT clinics navigate the complexities of insurance claims. By addressing the common pitfalls that lead to CO-22 denials, SPRY empowers clinics to enhance their billing practices and ensure seamless coordination of benefits with multiple insurers.

• Integrated EMR and Billing: SPRY combines electronic medical records and billing functions, reducing manual entry errors that can lead to incorrect insurance billing.

• Detailed Insurance Verification: The platform includes comprehensive verification tools that identify multiple insurance policies upfront, ensuring claims are submitted to the correct payer.

• Automated Claim Tracking: With automated alerts and tracking, SPRY keeps clinics informed about claim status and helps manage follow-ups, ensuring no claims are overlooked.

• Guided Documentation: SPRY emphasizes thorough documentation of services provided, ensuring all necessary details are captured to support claims and minimize denial risks.

To discover how SPRY can enhance your clinic's billing efficiency and minimize denial risks, schedule a demo today!

FAQs

1. What does Denial Code CO-22 mean?
Denial Code CO-22 indicates that the claim was denied because another insurance provider may be responsible for covering the service based on the coordination of benefits.

2. How can I avoid Denial Code CO-22?
To prevent CO-22 denials, ensure thorough verification of all insurance policies prior to claim submission and accurately identify the primary payer for each service.

3. What steps should I take if I receive a CO-22 denial?
Review the denial notice, verify the patient's insurance information, and resubmit the claim to the correct payer, ensuring all necessary authorizations are in place.

4. How does SPRY assist with CO-22 denials?
SPRY helps clinics manage insurance verification and submission processes effectively, reducing the likelihood of CO-22 denials through comprehensive tools and features designed for optimal billing practices.

‍5. Can multiple insurance policies affect my billing?
Yes, if a patient has multiple insurance policies, determining the primary payer is essential to ensure correct claim submission and avoid denials like CO-22.