Understanding Denial Code CO 22: Causes, Prevention, and Resolution

Denied claims are a significant issue in healthcare revenue cycle management. In 2024 alone, over 48 million healthcare claims were denied, creating financial and administrative burdens for practices. While completely eliminating denials is unrealistic, understanding common denial codes and implementing prevention strategies can drastically reduce their occurrence.

One of the most frequent denial codes is CO 22, which falls under the contractually obligated (CO) category. This means that the insurance company acknowledges the claim but denies it due to coordination of benefits (COB) issues. Let’s explore the causes of CO 22 denials and how to prevent and resolve them effectively.

What Is Denial Code CO 22?

Denial code CO 22 occurs when a patient has multiple insurance plans, and the insurance companies disagree on which one should be responsible for payment. This often happens when there is confusion about primary and secondary insurance responsibilities.

For example, if a patient has both a primary and secondary insurance provider, but the insurance companies are not properly coordinated, the primary insurer may deny the claim, stating that the secondary insurance should pay. This can result in delays and potential revenue loss if not handled correctly.

Common Causes of CO 22 Denials

Understanding the root causes of CO 22 denials can help prevent them before they impact your revenue cycle. Here are the most frequent triggers:

Incorrect Insurance Information

Mistakes during patient registration, such as incorrect insurance IDs or plan details, can lead to claim denials.

Missing Prior Authorization

Some services require pre-approval from insurance providers. Without it, claims may be denied or delayed.

Coordination of Benefits (COB) Issues

When it is unclear which insurance plan is primary and which is secondary, CO 22 is triggered. This can happen if the patient has changed insurance or if COB updates were not completed.

How to Prevent Denial Code CO 22

While CO 22 denials cannot always be avoided, implementing best practices can significantly reduce their occurrence. Here’s how:

Enforce Clear Office Protocols

Train front-office staff to verify and accurately record insurance details during patient registration.

Establish a standardized process for collecting and updating insurance information.

Leverage Technology

Use automated insurance verification tools to catch errors before claims are submitted.

Invest in practice management software that integrates COB checks.

Partner with a Clearinghouse

A clearinghouse reviews claims before submission, flagging potential issues and helping correct them proactively.

Stay Updated on Insurance Policies

Regularly check for policy updates and changes in COB rules to ensure accurate claim submission.

How to Resolve a CO 22 Denial

Even with the best prevention strategies, CO 22 denials can still occur. Here’s how to handle them efficiently:

Step 1: Review the Patient’s Insurance Policy

Verify if any updates or changes to the insurance plan have affected coverage.

Step 2: Check the Claim for Errors

Ensure that insurance IDs, policy details, and COB information are correct.

Step 3: Contact the Patient

If all details seem accurate, reach out to the patient to confirm their insurance information and determine the correct primary and secondary payer.

Step 4: Resubmit or Appeal the Claim

If an error is found, correct and resubmit the claim with updated details.

If the denial is incorrect, file an appeal with supporting documentation.

Conclusion

Denial code CO 22 can be a frustrating obstacle in medical billing, but with clear protocols, technology-driven solutions, and proactive claim management, healthcare practices can reduce its impact. By understanding the causes, implementing preventive measures, and following a structured resolution process, you can improve your revenue cycle and reduce claim denials.

For expert RCM solutions and denial management strategies, contact Svast Healthcare Technologies today!