CO-22 denial code: may be covered by another payer per coordination of benefits

Claim adjustment reason code 22 says: this care may be covered by another payer per coordination of benefits. The payer you billed believes another insurer should pay first, and won't pay until that one has.

With group code CO, the patient can't be billed for it. The fix is to bill the payers in the right order.

Coordination of benefits decides which plan is primary when a patient has more than one. Common rules:

• A patient's own plan is usually primary over a plan where they are a dependent.
• For children covered by both parents, many plans use the "birthday rule": the plan of the parent whose birthday comes first in the year is primary.
• Workers' compensation and auto or liability insurance pay first for injuries they cover.

When Medicare pays second

Medicare is the secondary payer in several situations, under the Medicare Secondary Payer rules, including:

• A patient aged 65 or over with group health coverage through their own or a spouse's current employment, at an employer with 20 or more employees.
• A patient with Medicare because of a disability who has group health coverage through a large employer, generally 100 or more employees.
• A patient with end-stage renal disease during the coordination period at the start of their Medicare entitlement.
• Injuries covered by workers' compensation, no-fault or liability insurance.

• The patient didn't mention their other coverage, or it started after their first visit.
• The order was set up the wrong way round in the patient's record.
• The patient hasn't updated their coordination of benefits information with their plan. Some plans hold claims until the member confirms whether they have other coverage.

1. Ask the patient about all their coverage, and confirm which plan is primary.
2. Bill the primary payer if it hasn't been billed.
3. Bill the secondary payer with the primary payer's payment information attached.
4. If the payer is waiting on the member, ask the patient to update their coordination of benefits details with the plan, then resubmit.

• Ask about other coverage at every visit, not just the first.
• For Medicare patients, use a Medicare Secondary Payer questionnaire at intake and update it periodically.
• Check eligibility responses for other coverage that the patient didn't mention.

CO-22 is decided by the order of payers, so it is prevented at booking.

Claira Health's AI agents confirm coverage and the right payer before the visit, so this denial is stopped at the front desk instead of coming back weeks later. Your team sees only what needs a decision, and approves every step. On a 20-minute call, we’ll walk through it using one of your own denials.

Book a 20-minute call and bring a coordination of benefits denial.