What is CO 22 Mean?
The CO 22 denial stands for “This care may be covered by another payer per coordination of benefits.”
It indicates that the claim has been denied because another insurance payer may be responsible for the payment.
This typically happens when the patient has multiple insurance coverages, and the Coordination of Benefits (COB) has not been verified or updated.
In simple terms —
The insurance is denying the claim because they think another insurance should pay before them.
Common Reasons for CO 22 Denial
1. Coordination of Benefits (COB) Not Updated
When a patient has more than one active insurance policy (for example, through their employer and spouse), insurance companies use the Coordination of Benefits (COB) process to determine which payer is primary and which is secondary.
If the COB details are not updated, the insurance company cannot determine payment responsibility and denies the claim until updated information is received.
Example:
The patient’s primary insurance changed last month, but the COB file still lists the old plan as primary. The claim is denied with code CO 22 until the updated information is confirmed.
2. Incorrect or Outdated Insurance Details
If the claim includes incorrect policy numbers, subscriber IDs, or group numbers, the payer cannot match the claim to an active plan.
Even a small typo or outdated insurance record can cause the payer to reject the claim, assuming another insurer is responsible.
Example:
The patient’s insurance ID was entered incorrectly by one digit, and the system failed to locate the correct coverage, resulting in a denial.
3. Claim Submitted to the Wrong Payer
This happens when a provider bills the secondary insurance before the primary or sends the claim to the wrong company.
In multi-plan cases, the insurance companies follow COB rules to decide which plan pays first. If the claim is sent to the wrong payer, it will be denied with code CO 22.
Example:
A patient has both Medicare and Blue Cross. The provider mistakenly bills Blue Cross first instead of Medicare. Blue Cross denies it with code CO 22, instructing the provider to bill Medicare first.
4. Patient Didn’t Respond to COB Verification
Insurance companies periodically send COB verification letters or questionnaires to patients to confirm if they have additional coverage.
If the patient does not respond, the payer places the policy on hold or denies claims until the COB information is verified.
Example:
The payer mailed a COB form to confirm if the patient still has secondary coverage. The patient ignored the letter, and the claim was denied with code CO 22.
5. Missing Explanation of Benefits (EOB)
When billing a secondary insurance, it’s mandatory to include the EOB from the primary payer showing what was paid or adjusted.
If this document is missing or incomplete, the secondary insurance cannot process the claim and issues denial code CO 22.
Example:
A provider submits a claim to the secondary payer without attaching the EOB from the primary. The claim is denied until the EOB is received.
On-Call Scenario: CO 22 – This care may be covered by another payer per coordination of benefits.
Step 1: Verify Denial Details
Ask: “May I get the denial date, please?”
Confirming the denial date helps you calculate the timely filing limit for resubmission or appeal.
Step 2: Identify the Primary Insurance
Ask: “Could you please tell me which insurance is listed as the primary payer?”
This step ensures you know which payer should have been billed first.
Step 3: Check if the Representative Has Details
If Yes:
Ask:
• “What is the effective and termination date of the policy?”
• “Was the policy active on the date of service?”
If Policy Active:
• “What is the policy ID, payer ID, and mailing address of the primary insurance?”
• “May I have the claim number and call reference number?”If Policy Inactive:
• “Could you please reprocess the claim since there is no active primary insurance?”
• “What is the turnaround time (TAT) for reprocessing?”
• “May I have the claim number and call reference number?”
If No:
Ask:
• “What is the policy ID, payer ID, and mailing address of the primary insurance?”
• “May I have the claim number and call reference number for documentation?”
Important Notes & Actions
1. Check for Existing Insurance Information
If the representative does not have the primary insurance details:
Review the billing system or patient payment history to check if another insurance exists.
If you find another policy listed as primary, check eligibility for that insurance.
If active: Resubmit the claim to the correct (primary) payer.
If inactive or no additional insurance is found: Release the claim to the patient for payment responsibility.
2. Use Payer Web Portals (If Accessible)
If you have access to the payer’s web portal, search for the patient’s primary insurance details.
This step helps identify any updated COB information or recent coverage changes that may not yet be reflected in your billing system.
3. Verify Eligibility When Details Are Provided
When the insurance representative shares primary payer information, always:
Verify eligibility through the web portal if access is available.
Sometimes, the primary insurance may appear active in the payer’s system but actually be inactive on the Date of Service (DOS).
If the primary insurance is inactive, ask the representative to reprocess the claim under the correct active coverage.
4. Update Insurance Sequence
Once all primary insurance details are verified:
Update the primary insurance in the patient’s profile.
Move the current payer to secondary insurance status.
Resubmit the claim to the correct primary payer.
This ensures claims are billed in the proper order and prevents repeat CO 22 denials.
5. If the Primary Insurance Has Already Paid
If the primary insurance has already processed and paid the claim:
Follow the Primary EOB Scenario (Click Here)
to ensure accurate posting and secondary claim submission.
Click here for more AR Scenarios and Denials.