CO-22 denial code
The payer believes another plan is primary and should pay first.
“This care may be covered by another payer per coordination of benefits.”
Start 01/01/1995 · Last modified 09/30/2007 · X12 adjustment reason code list
What it usually means in behavioral health
Behavioral health patients often carry more than one coverage, such as commercial plus Medicaid, or Medicare plus a supplement, and Medicaid is generally the payer of last resort.
An out-of-date coordination-of-benefits record at the payer is a frequent cause, even when your registration is right.
Common causes
- Payer's coordination-of-benefits record shows other coverage that's primary
- Primary payer not billed first, or its explanation of benefits not attached
- Member hasn't updated their coordination-of-benefits information with the plan
Correct and resubmit, or appeal?
Bill the primary payer first, then the secondary with the primary's explanation of benefits. If the payer's record is wrong, ask the member to update it with the plan, then ask for reprocessing.
What to do
Confirm all active coverage and which is primary.
Bill the primary, then the secondary with the primary's payment information.
If the payer's coordination-of-benefits record is outdated, have the member update it and request reprocessing.
Often seen with
- MA04
- N479
- N4
Got a CO-22 on your desk?
Send us the facts on that one denial — codes, payer, level of care, and dollar amount, no patient information — and within 2 business days we’ll tell you whether to correct or appeal, the deadline to watch, and what evidence would answer it. Free.