RemitBench/Denial codes/CO-19

CO-19 denial code

Code 19 sends the claim somewhere else entirely. The health plan is saying the injury happened at work, so a different carrier under a different set of rules owes the money.

The code list's own wording: This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.

Why the payer sent it

• The injury really was work related and a workers compensation claim exists.
• The patient mentioned work at intake and it was recorded as a work injury when it was not.
• The diagnosis suggested an occupational cause and the payer's edits acted on it.
• A prior work injury to the same body part is on file and this visit was linked to it.
• The employer disputes the claim, which leaves the patient between two carriers with neither paying.

Remark codes you will see with it

Read the letters in front of the 19

What to do next

1. Ask the patient whether this was a work injury

   Direct and early. The answer decides everything and the patient always knows, even when the paperwork does not.

   If yes: get the workers compensation carrier, the claim number and the adjuster. Those three facts are what you need and nothing else will do. If no: the health plan's record is wrong. That is a correction request, and the intake form is your evidence.

2. Check what your intake form says

   A tick in the wrong box at registration is a common cause. If your form says work related and the patient says otherwise, fix your record first.

3. Bill the compensation carrier, under their rules

   Workers compensation runs on its own fee schedules, its own forms and its own filing deadlines, which are often shorter. Do not assume your normal process applies.

4. If the claim is disputed, say so to the health plan

   A denied or disputed compensation claim usually reopens the health plan's obligation. Send the denial from the compensation carrier as evidence.

   If the compensation claim is denied: resubmit to the health plan with that denial attached. That is the normal route and it works.

Codes that get mixed up with 19

Codes 19, 20 and 21 are the same manoeuvre pointed at three different kinds of carrier: work, liability and no fault. All three mean somebody else pays and none of them mean the patient does.

Code 19 in dental

Dental practices meet this after workplace accidents that damage teeth: a fall, a blow, an industrial injury. It is uncommon and it is high value, because the treatment is often substantial and the compensation carrier usually pays it in full.

Ask at the first visit, not at the denial

A patient who broke a tooth at work rarely volunteers that fact to a dental office, because they do not think of it as an insurance question. Asking how the injury happened during the first visit gets the answer while there is still time to bill the right carrier inside its filing window.

Questions people ask about CO-19

Can I bill the patient for a CO-19?

Almost never. Workers compensation systems in most states protect the injured worker from being billed for treatment of a compensable injury. If the injury really was work related, find the compensation carrier. If it was not, the health plan's record is wrong and the fix is a correction rather than a patient statement.

What if the workers compensation claim is denied?

Then the health plan's obligation usually revives. Resubmit to the health plan with the compensation carrier's denial attached. That is the normal route out of this situation and it generally works.

Related codes

• CO-22 Another payer may be primary under coordination of benefits.
• CO-109 Not covered by this payer. Send it to the correct one.
• CO-23 The impact of a prior payer's adjudication.

Back to all denial codes