CO-109 denial code
This payer isn't responsible for the service, and the claim has to go to the payer that is.
“Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.”
Start 01/01/1995 · Last modified 01/29/2012 · X12 adjustment reason code list
What it usually means in behavioral health
Behavioral health carve-outs are the main cause. Many medical plans hand mental health and substance use benefits to a separate behavioral health administrator, and a claim sent to the medical plan comes back CO-109.
Medicaid managed care versus fee-for-service, and Medicare Advantage versus Original Medicare, cause the same result.
Common causes
- Behavioral health benefits carved out to a separate administrator
- Member moved to a different plan or product
- Medicaid or Medicare program mix-ups (managed care versus fee-for-service)
- Claim sent to the medical plan's claims address instead of the behavioral health administrator's
Correct and resubmit, or appeal?
Resubmit to the correct payer quickly. The filing deadline keeps running at the right payer, and not every payer accepts proof of timely filing to the wrong one, so check the contract.
What to do
Identify the correct payer or administrator from the member's card and the verification record.
Refile there right away, keeping the original submission proof.
Update registration so the next claim routes correctly.
Often seen with
- N130
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