Denials are playing a very important part in medical Billing, If denials are handled very carefully then revenue increased automatically. CO 109 Denial Code is a common denial in RCM so we learn how to handle this denial.
CO 109 Denial Code Description
Co 109 denial code means Claim or Service not covered by this payer or contractor, you may send it to another payer or covered by another payer.
Co 109 Denial Code Handling
If denial code co 109 occurs in any claims that mean the patient has another payer or insurance and the patient did not update info that which is primary ins and which is secondary ins. Mostly due to this reason denial CO-109 or covered by another payer denial comes.
The below steps we have to follow to handle this denial
1- At the first user should check patient eligibility on a given website if found other insurance information is already updated then the claim is billed to that insurance as the correct one.
2- If no website is available to check eligibility then user should call the insurance company that gave denial and ask them if there is any other ins information available, some times they provide other insurance information with a policy id number and active and term date. User should update information and bill that one.
3- If not found other insurance information by website and call, then if there is client instruction for the patient billing, the user should be billed claim to the patient, and when the patient receives a bill of claim he/she update the correct COB(Co-ordination of benefit).
4- In some cases procedure is to call the patient directly and ask them to update the correct COB information but it depends on the client’s SOP.
Note- Denial code 22 or CO 22 denial code also described as “This care may be covered by another payer per coordination of benefits” User should have followed the same procedure to handle the denial as above.
COB- Coordination of Benefit Rule:
COB is a short form of Coordination of Benefit. If the patient has more than one insurance coverage, then the COB rules determine and decide which will be the primary, and which one is secondary insurance and the tertiary as well. This rule is to avoid no duplication of payments and paid by the correct payer respectively.
When a patient is having more than one medical insurance policy, then it is the patient responsibility to update all of his/her insurance policy information and the order of payment as to which will be the primary and which one is secondary insurance.
Co 109 denial code and denial code 22 both are working in the same way and have very minor differences but mostly both are handled in the same way.